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. 

CMS draws line on reforms by rejecting lifetime limits in Medicaid

Kansas’s proposal to impose a three-year lifetime limit on Medicaid benefits has been formally rejected by CMS, with Administrator Seema Verma, MPH, saying the agency has to ensure the program “remains a safety net for those that need it most.”

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CMS approves New Hampshire to impose Medicaid work requirements

New Hampshire will become the fourth state to impose work requirements on Medicaid beneficiaries, according to a May 7 joint statement from CMS, HHS and New Hampshire Governor Chris Sununu.

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Trump claims ACA is dead—but IRS still plans to enforce employer mandate

At last week’s campaign-style rally in Michigan, President Donald Trump claimed he’d done away with the Affordable Care Act (ACA) when the 2017 tax bill repealed the individual mandate. But folks at the Internal Revenue Service (IRS), though, would disagree. A recent report from the New York Times examines IRS's plan to send out penalty notices to more than 30,000 businesses in the U.S.

Elliott makes $7B all-cash bid for Athenahealth

According to CNBC, Elliott Management made an all-cash deal for Athenahealth on Monday morning. Elliott’s bid is for $160 a share—a 27 percent premium to the Massachusetts-based healthcare technology company’s Friday afternoon price.

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Partners HealthCare talking merger with insurer Harvard Pilgrim

One of Massachusetts’ largest health insurers, Harvard Pilgrim, has been discussing a merger with the state’s dominant healthcare provider, Partners HealthCare, in a move that could dramatically alter the increasingly consolidated market in and around Boston.

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HHS sued over failing to release communications on family planning grants, religious freedom

HHS is the target of new lawsuits by a watchdog group for failing to respond to requests to release emails and online messages—one regarding Office of Civil Rights (OCR) officials and launching of its “Conscience and Religious Freedom Division,” the other over HHS communications with outside groups on changes to a federal grant program that provides birth control and other reproductive health services to low-income Americans.

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Upside-only ACOs will leave if forced to take on downside risk

If participants in the Medicare Shared Savings Program (MSSP) are required to move into a track which involves downside risk for their organization, they’re likely to leave the program altogether, according to the results of a survey from the National Association of Accountable Care Organizations (NAACOS).

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Moody’s: For-profit hospitals’ outlook stable but value-based care investments are needed

Moody’s Investors Service maintained its stable outlook for the for-profit hospital industry, predicting some small growth in same-facility revenues and patient volumes while margins would remain flat. Looking ahead, however, it advises facilities to pay more attention to value-based care concepts and new technologies like telemedicine and artificial intelligence.

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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