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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CMS delays deadline for opting into bundled-payment initiative

CMS bumped back the due date for providers to opt into the Bundled Payments for Care Improvement (BPCI) Advanced model—moving the final date to Aug. 8 from Aug. 1. The move comes in amid growing concerns from those in the industry that claims data were not provided in a timely fashion.

CMS approves Oklahoma proposal for value-based Medicaid agreements with drug manufacturers

CMS has issued an approval to Oklahoma to negotiate value-based supplemental rebate agreements directly with drug manufacturers, which could produce extra rebates for state, should clinical outcomes not be achieved.

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CMS policy to reduce hospital-acquired infections has minimal impact on reimbursement

New research published in Infection Control & Hospital Epidemiology suggests the 2008 CMS’ policy, Hospital Inpatient Prospective Payment System (IPPS), which penalizes hospitals for hospital-associated conditions (HAC) present at the time of the patients’ admission to the hospital has had a minimal impact on hospital reimbursement.

Medicaid benefits could be cut if work requirements aren't fixed, implemented quickly

On Friday, a federal judge denied Kentucky’s move to impose work requirements on some Medicaid recipients. Now, one Kentucky official claims benefits will be cut if this policy isn't fixed and implemented quickly.

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Kentucky Medicaid work requirements shot down by federal judge

Kentucky was set to become the first state in the U.S. to impose work requirements on Medicaid recipients. But a federal judge blocked the move, which was set to take effect on Sunday—claiming the Trump administration didn’t properly consider the policy’s effect on the program’s intended aim to provide medical coverage to at-risk populations.

9 accused of submitting $950M in fraudulent health insurance claims

Federal prosecutors in California announced charges against nine individuals—including orthopedic surgeons, chiropractors and a C-suite executive—for allegedly running a 15-year scheme that submitted nearly $1 billion in fraudulent health insurance claims to the federal government, California and private insurers.

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Healthcare top priority for 25% of voters; 66% back protections for pre-existing conditions

Just over four months away from the 2018 midterm elections, healthcare promises to be a major topic of discussion as campaigns head toward the finish line. According to a recent poll, 25 percent of registered voters said healthcare was the No. 1 issue for this election cycle.

Medicare spending hits $702B in 2017, will top $1T in 2026

The Kaiser Family Foundation released an issue brief June 22 that projected total Medicare spending to top $1 trillion by 2026, up from a total of $702 billion last year, according to Congressional Budget Office and CMS data.

Around the web

The FTC alleges that pharmacy benefit managers have set up a system where they get rich, while patients are forced to pay rising insulin costs. The agency also called out drug manufacturers such as Eli Lilly, Sanofi and Novo Nordisk, saying their own actions have raised serious concerns.

In the post-COVID era, wages for permanent RNs are rising, and wages for travelers are decreasing. A new report tracked these trends and more. 

Two medical device companies have announced a transaction that could shake up the U.S. electrophysiology market. 

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