Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

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Maine’s stalled Medicaid expansion heading to court

Maine became the first state to approve Medicaid expansion at the ballot box. Despite 59 percent of voters approved of expansion, Gov. Paul LePage has taken several steps which have stalled its implementation.

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Envision’s lawsuit against UnitedHealthcare dismissed

Envision had sued the insurer in March, alleging UnitedHealthcare “unilaterally” negotiated payment rates and failed to add Envision physicians to its network after the acquisition of AmSurg in 2016. UnitedHealthcare argued Envision’s emergency room billing practices were “egregious,” but also said the lawsuit itself was a violation of the arbitration provision in their contract.

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3 things to know about CMS payment rules for skilled nursing, inpatient rehab, hospices

CMS published several of its annual proposed Medicare payment rules on Friday afternoon, covering a slew of facilities like nursing homes, hospices, inpatient rehabilitation and psychiatric hospitals. As predicted, the proposed rule also included regulatory changes in line with CMS initiatives on reducing administrative burden and granting patients easier access to their own data.

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California congressman proposes testing automatic enrollment in ACA plans

In states that choose to utilize federal grants for the pilot program, those who don’t want coverage would have to actively opt out of plans within 60 days.

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Hospital M&A activity expected to continue brisk pace in 2018

If the first quarter of the year is any indication, the frantic pace of mergers and acquisitions (M&A) among hospitals won’t be slowing down in 2018. Thirty transactions were announced between January 1 and March 31, an 11 percent increase over the same period in 2017, according to Kaufman Hall.

Amazon already tried—and failed—to disrupt pharmaceuticals

In 1999, Amazon bought a 46 percent stake in Drugstore.com and began marketing its products on the Amazon site. Once hailed as “a likely gold mine,” the venture never turned a profit after running into problems with regulations, logistics and the existing pharmacy benefit managers that already dominated the market.

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Hospitals largely supportive of 2019 IPPS proposed rule

Fewer quality measures, a shorter reporting period for Meaningful Use requirements and an increase in uncompensated rate payments were all positives in the eyes of hospitals in their initial reaction to the proposed 2019 Medicare Inpatient Prospective Payment System (IPPS) rule.

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Welltower partners with ProMedica to acquire Quality Care Properties

Healthcare real estate investor Welltower has announced it will acquire the outstanding shares of Quality Care Properties and form a joint venture with Toledo, Ohio-based health system ProMedica for the real estate holdings of QCP tenants HCR ManorCare and Arden Courts.

Around the web

If passed, this bill would help clinician-led clinical registries explore Medicare data for research purposes. The Society of Thoracic Surgeons and American College of Cardiology both shared public support for the bipartisan legislation. 

Cardiologists and other physicians may soon need to provide much more information when ordering remote patient monitoring for Medicare patients.

Why are so many cardiovascular devices involved in Class I recalls? One possible reason could be the large number of devices hitting the market without undergoing much premarket clinical testing. 

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