As the 117th Congress moves into its second legislative session, there is no shortage of health care policy issues dotting the landscape. The COVID-19 pandemic, legislative gridlock and a 2021 that was largely locked down by...more
Each year, the health plans that participate in Medicare Advantage (MA) program compete vigorously for new members. This vigorous competition has fueled the program’s 10% annual growth rate in recent years. MA plans can...more
On June 9, 2021, Arnold Ventures, researchers from the Boston University School of Public Health and Faegre Drinker hosted a virtual event to explore the issue of fraud in substance use disorder (SUD) treatment. In response...more
On May 12, 2021, the Institute for Clinical and Economic Review (ICER or the Institute) released plans to begin an annual examination into health insurance drug coverage policies to assess “fair access” to prescription drugs....more
Medicare Advantage (MA) is the private plan option in the Medicare program. Enrollment in the program has grown nearly 10% a year in recent years and now tops 25 million. More than one-third of Medicare beneficiaries (people...more
Medicare Advantage (MA) is the rapidly growing private plan option in the Medicare program. More than one-third of all Medicare beneficiaries choose MA — more than 24 million people. The program has grown nearly 10% year over...more
The Centers for Medicare & Medicaid Services (CMS) has issued guidance on how health insurers must report and rebate recoveries obtained from the federal government under the Supreme Court’s 8-1 decision in Maine Community...more
On August 31, 2020, the Centers for Medicare & Medicaid Services (CMS) proposed a rule to align Medicare coverage decisions with breakthrough technologies approved by the Food and Drug Administration (FDA), thereby speeding...more
Cost-Sharing Reduction (CSR) Payments Take Effect. Under Section 1402, the Affordable Care Act (ACA) implements a plan for reducing the amount of out-of-pocket costs, such as deductibles and co-payments, that lower-income...more
Many health insurers and HMOs may be considering entering or reentering the individual health insurance market, either on or off a federal or state-based health insurance marketplace. Over the last two years, the individual...more
On June 3, the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced long-awaited policies to address the impact of COVID-19 on its ongoing models, as well...more
Medicare Advantage (MA) is the private plan option in the Medicare program. Over the last few years, the program has grown rapidly, nearly 10% a year. More than one-third of Medicare beneficiaries (people with Medicare) have...more
On February 5, the Centers for Medicare and Medicaid Services (CMS) proposed several interesting tweaks to the Medicare Advantage (MA) and Medicare Part D programs through an 895-page proposed regulation, Contract Year 2021...more
Over the last five years, clinicians, health plans and policymakers have ramped up their focus on the social determinants of health (SDOH). SDOH are non-medical factors (food security, housing security, reliable access to...more
On October 3, President Donald Trump signed an executive order (EO) focused on the Medicare program, titled, “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors.” The EO offers expected political...more
New payment models – both voluntary and mandatory – are on the way for Medicare-participating providers treating kidney disease and offering radiation oncology services.
On July 10, the White House, in conjunction with the...more
On April 24, Centers for Medicare and Medicaid Services (CMS) issued a memo to Medicare Advantage (MA) plan sponsors detailing the scope of Special Supplemental Benefits for the Chronically Ill (SSBCI). Established by the...more
On April 22, The Center for Medicare and Medicaid Innovation (the Innovation Center) at the Centers for Medicare and Medicaid Services (CMS) announced a new Primary Cares Initiative, with two new payment models aimed at...more
A federal judge has ruled that health insurers under the Affordable Care Act are entitled to unpaid cost-sharing reduction (CSR) payments from the government. Insurers sued following the Trump administration’s October 2017...more
Medicare Advantage, the private plan option in the Medicare program, is growing rapidly. Currently, 22 million people choose Medicare Advantage — more than one third of people with Medicare — and that number is expected to...more
The opioid epidemic is causing a rise in the number of treatment centers and recovery residences that offer services for people with substance use disorder (SUD). SUD treatment and recovery entities are less regulated than...more
A federal district court in Fort Worth, Texas struck down the entire Affordable Care Act (ACA) last Friday in a ruling that’s prompting questions about whether its legal reasoning will withstand further scrutiny, and whether...more
On October 26, the Centers for Medicare and Medicaid Services (CMS) released a 362-page proposed regulation that makes changes to three expected areas:
- New telehealth flexibilities for Medicare Advantage (MA) plans....more
The Trump Administration released a draft regulation published in the Federal Register on October 18, 2018, which proposes to require drug manufacturers to include a drug’s list price in its direct-to-consumer (DTC)...more
On Friday, May 11, 2018, President Trump delivered a highly anticipated speech addressing high drug prices and unveiling his administration’s blueprint to lower drug prices and reduce out-of-pocket costs. American Patients...more