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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GAO report: HHS didn’t violate laws by lobbying against ACA

The U.S. Department of Health and Human Services did not violate certain legal provisions when it reduced public outreach to alert people to healthcare enrollment periods and put out social media posts that blasted Obamacare, according to the Government Accountability Office.

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Medicaid expansion pays off the most for rural states

Small towns and rural areas saw the biggest benefits of Medicaid expansion under the Affordable Care Act, according to a recent report.

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Readmission penalties reduced for safety-net hospitals

Hundreds of hospitals will see penalties on patient readmissions ease up after Congress instructed Medicare to change its policy, NPR reported.

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Verma defends Medicaid work requirements after thousands lose coverage

CMS Administrator Seema Verma went to bat for Medicaid work requirement programs, which have been implemented or approved in a handful of states, even as thousands of beneficiaries are on course to lose healthcare coverage as a result of these rules.

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WellCare to buy Aetna’s Part D biz in CVS deal divestiture

CVS Health’s $69 billion acquisition of health insurance giant Aetna is not going to complete without divestments. WellCare Health Plans, a Tampa-based managed care company, has agreed to acquire Aetna’s entire Medicare Part D prescription drug plan business, which encompassed 2.2 million members as of June 30.

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Hospital patients in outpatient settings are sicker, poorer

Medicare patients who receive hospital outpatient care are more likely to be poorer and have more severe chronic conditions compared to those treated in an independent physician office, according to a study commissioned by the American Hospital Association.

Medicaid spending hit $581B in 2016

In 2016, Medicaid spending reached $581 billion—the highest level ever for the federal program—and covered an estimated 72 million beneficiaries. Over the next decade, spending is projected to rise 5.7 percent a year, topping $1 trillion by 2026.

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PBMs blame insurers for high drug prices

Pharmacy benefit managers (PBMs)—the industry middlemen that negotiate drug prices—are passing on nearly all their savings to insurance providers, according to Terry Wilcox, co-founder and executive director of advocacy organization Patients Rising. His op-ed for The Hill placed the blame of high costs squarely on insurers.

Around the web

Compensation for heart specialists continues to climb. What does this say about cardiology as a whole? Could private equity's rising influence bring about change? We spoke to MedAxiom CEO Jerry Blackwell, MD, MBA, a veteran cardiologist himself, to learn more.

The American College of Cardiology has shared its perspective on new CMS payment policies, highlighting revenue concerns while providing key details for cardiologists and other cardiology professionals. 

As debate simmers over how best to regulate AI, experts continue to offer guidance on where to start, how to proceed and what to emphasize. A new resource models its recommendations on what its authors call the “SETO Loop.”