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A New Advantage in Medicare: New Benefit Flexibilities Will Change Medicare Advantage

A provision included in the recently enacted budget law will now make it much easier for Medicare Advantage (MA) plans to offer a wide array of supplemental benefits within their plans. This will create new opportunities for...more

ACA Litigation Update: Will More Insurers File CSR Lawsuits in 2018?

On October 12, 2017, the Trump administration announced that it would immediately stop making cost-sharing reduction (CSR) subsidy payments under Section 1402 of the Affordable Care Act (ACA). CSRs allowed — and in fact...more

ACA Risk Corridors Update: Federal Circuit Holds Oral Argument in the Land of Lincoln and Moda Cases

In a crowded courtroom on January 10, the U.S. Court of Appeals for the Federal Circuit held oral argument on appeals of two Risk Corridors decisions from the Court of Federal Claims. The two cases, Land of Lincoln and Moda,...more

State Regulator Enforces Network Adequacy Standards on ‘Obamacare' Health Plan: Will More Actions Follow?

In what may be the first enforcement action taken by a state regulator against an “Obamacare” health plan for provider network problems, the Washington State Office of the Insurance Commissioner imposed a fine and suspended...more

ACA Risk Corridors Update: Trump Administration Releases 2016 Amounts, Paving the Way for Litigation Over Amounts Owed

On November 13, 2017, the Centers for Medicare & Medicaid Services (CMS) announced its Risk Corridors payment and charge amounts for the 2016 benefit year. This event is significant in that it both acknowledges and quantifies...more

A Step Toward ‘Replace' Without the ‘Repeal': The Trump Administration Re-Regulates Obamacare

On Friday, October 27, the Centers for Medicare and Medicaid Services (CMS) published its draft annual Proposed Notice of Benefits and Payment Parameters for Calendar Year 2019. This proposal follows on the heels of a Request...more

CSR Litigation Update: California Court Denies States' Motion for Preliminary Injunction – What Does This Mean for Health...

On October 25, 2017, in the case State of California v. Trump, the U.S. District Court for the Northern District of California denied a motion brought by 17 states seeking to order the Trump administration to resume...more

What Can Health Plans Do Now That the Trump Administration Has Stopped Making CSR Payments?

On October 12, 2017, the Trump administration announced that it will immediately stop making cost-sharing reduction (CSR) subsidy payments, which allow health insurers to defray out-of-pocket costs to insure low-income...more

The Graham-Cassidy Bill: Evaluating the Latest ACA Repeal Measure

Last week, the Senate unveiled the Graham-Cassidy Bill, Republican legislators’ latest attempt to repeal the Affordable Care Act (ACA). Crafted by Sens. Bill Cassidy, R-LA, Lindsey Graham, R-SC, Dean Heller, R-NV, and Ron...more

In Removing HSD Tables From Applications, CMS Opens the Door to Medicare Advantage Growth

Recently, the Centers for Medicare & Medicaid Services (CMS) released its draft 2019 Medicare Advantage application. Health plans seeking to participate in the Medicare Advantage (MA) program for the first time or expanding...more

Telehealth Remains a Top Priority for Advancing Quality Health Care

Even with the prospect of Obamacare repeal and replace on the backburner for now, the federal government continues to focus on health care. Following August recess, Congress will have less than four weeks to work through...more

What Can Health Plans Do if the Trump Administration Stops Making CSR Payments?

Amid assertions that the Affordable Care Act (ACA) should be allowed to fail, the Trump administration has indicated that it may stop paying subsidies that are central to ACA markets. At the core of these subsidies are...more

The Better Care Reconciliation Act: Assessing the Senate's AHCA Counterpart

On June 22, the Senate unveiled its counterpart to the House of Representatives’ American Health Care Act (AHCA) — the Better Reconciliation Act (BCRA) — and Republican leaders have reportedly indicated a desire to vote on...more

Two States Make Strong Statements About Their Obamacare Markets

Since last November’s election, the future of the Affordable Care Act (ACA) has been very much in doubt. It can be debated whether the health insurance exchanges (Exchanges) are in a “death spiral” as President Trump...more

An Unsettling Settlement: Health Plan to Pay $32 Million to Settle Coding and Provider Network Misrepresentation Charge

On May 30, the Department of Justice (DOJ) announced that it reached a settlement with commonly-owned Freedom Health Inc. and Optimum Healthcare, Inc. (Freedom Health) — two Tampa, Florida, managed care plans — to settle...more

For Health Insurers, Court Decisions Continue to Complicate Risk Corridors Program Payments

For health insurers concerned about when they may receive government payments through the Affordable Care Act’s (ACA) risk corridor program, court decisions have provided little clarity. An April 18 decision by Judge Griggsby...more

Market Stabilization Rule: Assessing the Trump Administration's First ACA Market-Related Regulation

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized its Marketplace Stabilization Rule. This is the first Trump administration regulation that applies to the health insurance markets remade by...more

Side by Side Comparison – The Affordable Care Act and the American Health Care Act

The House plans to vote on the American Health Care Act (AHCA) on Thursday. While this is only the beginning of the political and legislative process for the so-called Obamacare repeal bill, it’s important for health care...more

House Moves Forward With Its ACA Repeal Bill – What You Need to Know

After months of intense debate, raucous town hall meetings and a fair share of leaks, House Republicans on Monday officially released their bill to repeal the Affordable Care Act (ACA) and to reform the Medicaid program—less...more

President Trump Props Up the ACA: A Summary of the New Administration's ACA Market Stabilization Regulation

On February 15, President Trump and new Department of Health and Human Services (HHS) Secretary Tom Price released their first proposed regulations addressing the Affordable Care Act (ACA). While remaining committed to...more

The Replacements: Understanding the GOP's Leading Health Care Plans

With the repeal of the Affordable Care Act (ACA) looking imminent, Faegre Baker Daniels and Faegre Baker Daniels Consulting have created a one-page resource identifying and assessing the six leading replacement plans making...more

Breach of Privacy Prompts Breach of Etiquette: DHHS Sets New Precedent in Privacy Breach Enforcement

On January 9, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) took action against a health system for non-timely reporting of a breach of protected health information. It was the first...more

Transparency's Opaque Beginning: CMS Starts Implementing ACA Transparency Requirements

Based on QHP Certification instructions issued on July 22, 2016, the Centers for Medicare and Medicaid Services (CMS) will collect administrative and performance data from health insurers that participate in the federally-run...more

Broad Examination of Narrow Networks: First-of-Its-Kind Study Examines Hospitals in Medicare Advantage Plans

On June 20, 2016, The Kaiser Family Foundation issued the first ever broad-based study of Medicare Advantage hospital networks. The study — "Medicare Advantage Hospital Networks: How Much Do They Vary?"— analyzed 409 plans in...more

6/23/2016  /  HMOs , Hospitals , Medicare , Medicare Advantage

Whether Naughty or Nice, Recovery Audit Contractors Are Coming to Medicare Advantage

During the holiday season lull, the Centers for Medicare and Medicaid Services (CMS) issued a weighty document. The agency put out a draft statement of work to procure Recovery Audit Contractors (RACs) for the Medicare...more

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