Tagged with ACA Affordable Care Act
CMS posted a final rule that reissues, with additional explanation, the risk adjustment methodology that CMS previously established for transfers, charges, and making of payments related to the 2017 benefit year.
CMS has issued a rule finalizing 2019 updates to Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) and to the IPF Quality Reporting (IPFQR) Program.
Highmark has announced that beginning October 1, eviCore will manage prior authorizations for Highmark members with non-emergent conditions requiring musculoskeletal (MSK) surgery or interventional pain management (IPM) services.
The Department of Labor (DOL), on June 18, issued a final rule that will expand consumer availability of association health plans (AHPs) as of September 1, 2018.
A resolution has been introduced in Delaware that seeks to allow the state to look-into potential Medicaid buy-in options.
The Virginia House of Delegates recently passed a state budget that includes funding for Medicaid expansion and stricter work requirements. If finalized, the state budget legislation would expand Medicaid eligibility to about 400,000 low-income adults.
The New Jersey Legislature recently approved two bills targeting state healthcare stabilization, as well as measures to protect patients from surprise out-of-network costs.
The Governor of Maryland has passed legislation which seeks to stabilize Maryland’s health care insurance market and prevent rates from increasing.
Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.
CMS and the Department of Health and Human Services (HHS), on April 9, issued the Notice of Benefits and Payment Parameters (NBPP) final rule for plan year 2019, updating policies and standards applying to qualified health plans (QHPs) offered on Affordable Care Act (ACA) Exchanges.
The New Hampshire House Health and Human Services Committee and Senate have passed legislation to reauthorize the state’s Medicaid expansion program for an additional five years, as well as add work requirements, and will also transition beneficiaries from the individual insurance exchange into a managed care model.
According to a new state report, the state of Maryland has seen reductions in hospital admissions and increased cost savings in the first three years since moving forward with its All-Payer Hospital Model.
The Department of Health and Human Services (HHS) has announced its plans to overhaul the way the federal government reimburses providers. The Department states, in an effort to improve technology and transparency, it will make changes to interoperability, price transparency, and care delivery through Medicare and Medicaid, and remove regulations that hinder private innovation.
Nine states and the District of Columbia have announced they are considering laws that would require residents to purchase health insurance. Connecticut, Rhode Island, New Jersey, and Vermont, are amongst the states considering the state mandates to replace the recently repealed federal individual mandate.
The Senate has reached its two-year budget deal which includes a 10 year extension to CHIP, funding to combat the opioid epidemic, and repeal of the Medicare Independent Payment Advisory Board.
The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) recently announced that the repeal of the Affordable Care Act’s (ACA) individual mandate will significantly cut the cost to fund the Children’s Health Insurance Program (CHIP) for five more years.
The Texas Health and Human Services Commission has requested $90 million in additional funding from CMS in hopes of keeping the state’s Children’s Health Insurance Program (CHIP) afloat through February 2018.
The Ohio Controlling Board voted unanimously to continue funding for the state’s Medicaid Program, releasing $264 million in state funding needed to qualify for $638 million in federal matching funds.
The U.S. House of Representatives voted 242-174 to reauthorize federal funding to maintain low-cost health insurance to 8.9 million children and 370,000 pregnant women under the Children’s Health Insurance Program (CHIP). The Healthy Kids Act extends CHIP’s federal funding for five years and federally qualified health centers for two years.
Two Senate health committee leaders announced their joint plan for a short-term deal on a bipartisan health care deal aimed at stabilizing the individual insurance market by extending cost-sharing subsidy payments to insurers for two years.