Tagged with Healthcare Reform
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
The American College of Radiology (ACR) is seeking help in its efforts to urge Congress to stop CMS from implementing proposed changes to the Evaluation and Management (E/M) Codes that could result in severe cuts to radiology.
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
The Illinois Legislature unanimously passed a health care reform package, which requires Medicaid managed care plans to pay claims within 30 days or face a penalty.
The Texas legislature has passed three patient protection bills aimed at Medicaid managed care and safeguarding against surprise medical bills.
CMS, along with the HHS, has announced plans to launch five new Medicare primary pare payment models.
The Promoting Integrity in Medicare Act (PIMA) seeks to update Medicare policies by preventing self-referrals related to advanced imaging services, radiation therapy, anatomic pathology and physical therapy.
A New Hampshire senator has announced plans to file legislation that is designed to address surprise medical bills that some patients say keep coming after a visit to the emergency room for an illness or injury.
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
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.
New York Finalizes Draft Waiver Transition Plan for Individuals with Intellectual and Developmental Disabilities
The New York Office for People with Developmental Disabilities (OPWDD) has finalized its Draft Waiver Transition Plan which lays out their vision for reform of the system serving people with intellectual and developmental disabilities (IDD), “People First Care Coordination.” The Transition Plan describes the development of Care Coordination Organizations, which will provide Health Home Care Management services.
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.
Providers and insurance groups are in favor of CMS’ plans to develop a demonstration project that will test the effects of allowing clinicians to receive credit for financial risk-based arrangements with Medicare Advantage (MA) plans.
The New Jersey Department of Human Services (DHS) last month announced that it has expanded the list of covered health benefits available to align behavioral health coverage for Medicaid Long Term Services and Supports (MLTSS), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and Division of Developmentally Disabled (DDD) MCO members participating in the New Jersey FamilyCare (NJFC) Medicaid managed care program.
Massachusetts Senate leaders have released a comprehensive health care legislation containing a wide range of provisions that, if finalized, would require the state to report the top 50 employers with the highest number of employees who receive coverage through MassHealth as well as require those companies identified to pay a large portion of a $200 million assessment to cover funding shortfalls in the state’s Medicaid program, MassHealth.
CMS has released a new policy intended to allow states the ability to design demonstration projects toward increased access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD).
Massachusetts is seeking federal permission to move adults off Medicaid by curbing access to in-home and long-term care supports and limiting drug coverage.
The Medical Imaging and Technology Alliance (MITA) has issued new guidelines for live model ultrasound scanning for educational purposes.