The CMS Interoperability and Prior Authorization Rules
Podcast — Drug Pricing: How Are Payers Responding to the IRA?
Findings from Gibbins’ Annual Healthcare Bankruptcy Report
A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration
Video: Braidwood v. Becerra – Challenging the Affordable Care Act’s Preventive Services Coverage Provision – Thought Leaders in Health Law
Hospice and Home Health Survey Perspectives: A Conversation with Kim Skehan, VP of Accreditation at CHAP
Transparency and the Open Payments Program
Taking the Pulse, A Health Care and Life Sciences Video Podcast | Episode 173: Improving rural health care with Dr. Kevin Bennett, the Director of the Research Center for Transforming Health and the
Counsel That Cares - The Private Payer's Perspective on Value-Based Care
Podcast: Health Equity – Behind the Buzzwords – Diagnosing Health Care
A Very “Special” Episode: Amid Controversy, CMS Launches the Hospice Special Focus Program
Grace from CMS: Unexpected Good News on HIS and CAHPS Appeals
This Bandwagon Has a Broken Wheel: OIG Joins the Inconsistent Approach to Hospice GIP Claims
Behind the Curtain: Enhanced Provider Enrollment Oversight
Survey Woes: CMS Ramps Up Hospice Survey Program and Consequences
Inflation Reduction Act’s Drug Price Negotiation Provisions – What Now? – Diagnosing Health Care Podcast
A Glimpse Into the Other Side: Understanding the Perspective of Government Enforcers
I Understood There Would Be No Math: Audits, Extrapolations, and a New Set of Rules
Podcast: Inflation Reduction Act’s Drug Price Negotiation Provisions – What’s Next? - Diagnosing Health Care
On October 20, 2020, CMS approved Nebraska’s Medicaid expansion program – named the “Heritage Health Adult,” or HHA – under Section 1115 of the Social Security Act, creating a new two-tiered system of Medicaid benefits for...more
The Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS), the Office for Civil Rights (OCR), the Office of the Inspector General (OIG), and other Federal and State agencies and...more
With crisis comes uncertainty, and even the best-intentioned regulations can leave those combating the current COVID-19 public-health emergency out in the cold. Many have asked whether the recent Declaration under the...more
This post is the second installment in our blog series looking back on the 10-year anniversary of the Affordable Care Act (ACA) and will examine Medicaid expansion under the ACA. Medicaid is joint federal-state program that...more
In light of findings from the COVID-19 outbreak at a nursing home in Kirkland, Washington, the Centers for Medicare and Medicaid Services (CMS) has announced that it will suspend all routine facility inspections and surveys...more
On January 30, the Department of Health and Human Services (HHS) released long-anticipated guidance that invites states to pursue capped funding demonstrations for the Affordable Care Act Medicaid expansion population as well...more
Over the past several years, federal Medicaid oversight and advisory bodies, including the Government Accountability Office (GAO) and the Medicaid and CHIP Payment and Access Commission (MACPAC), have issued reports calling...more
Health care issues will remain a central focus in Washington throughout 2019. Having gained control of the House following the 2018 mid-term elections, Democrats now have the ability to block President Trump's legislative...more
As of December 2018, 37 states (including DC) have adopted Medicaid expansion. Of the remaining 14 states, some are considering expanding Medicaid. States with recent activity relating to Medicaid expansion include – Florida,...more
Healthcare was a top voter priority in the 2018 midterm elections, with 41 percent of national voters stating that healthcare was their "most important" issue. Accordingly, the Democratic strategy to focus on healthcare...more
Congress passed a funding bill early this morning just after the February 8th deadline. The new legislation will make several changes to the Medicare program, delay cuts to disproportionate share hospitals, provide two years...more
Arkansas - Governor Proposes Changes to Medicaid Expansion Waiver as House Passes Bill to Cap Expansion Enrollment - Governor Asa Hutchinson (R) released a proposal to amend the State's Medicaid expansion waiver by...more
HealthCare.gov enrollment is down, while State-based Marketplace enrollment is up at the end of 2017 open enrollment; Hawaii, Massachusetts and Oregon introduce legislation to codify ACA reforms in state law in case of...more
New repeal and replace legislation would shift some decisions on ACA reforms to states; President Trump signs an ACA executive order; and a Kansas legislator introduces a new Medicaid expansion bill....more
CBO estimates 27 million would lose coverage under partial ACA repeal in the first year after elimination of Marketplace subsidies and Medicaid expansion; a federal judge orders delay in submission of North Carolina’s...more
Physician groups and American Enterprise Institute authors come out against ACA repeal without a replacement; Hawaii’s 1332 waiver is the first to receive federal approval; and North Carolina’s Governor moves to expand...more
Arkansas - Task Force Report Highlights Expected Cost Savings From Medicaid Expansion - The Arkansas Health Reform Legislative Task Force met for the last time to approve its final report, which includes findings...more
The National Association of Medicaid Directors offers policy considerations and recommendations to the incoming Administration; HealthCare.gov has its largest single day of enrollment ever; and new publications prepared by...more
Congressional Republicans ask states for guidance on new healthcare legislation while insurers and providers urge caution; new reports find ACA repeal would increase uninsurance rates and cut billions of dollars in funding to...more
President-elect Trump taps prominent conservatives with strong anti-ACA views for his healthcare transition team; House v. Burwell proceedings on cost-sharing reductions for Marketplace plans are delayed until the new...more
President-elect Donald Trump announced on November 28, 2016, that current House Budget Chair Representative Tom Price is his choice for Health and Human Services (HHS) Secretary. Many providers are wondering what health care...more
The incoming Trump Administration selects HHS and CMS leadership; Alaska moves forward with its proposed 1332 waiver for its ACA reinsurance program; and a new Manatt Health report considers the role of Medicaid supplemental...more
National News - Medicaid Expansion Is Associated With Improved Hospital Finances, Study Finds - Hospitals in Medicaid expansion states saw “significantly increased” Medicaid revenue, decreased uncompensated care...more
HealthCare.gov consumers begin previewing 2017 coverage options as HHS projects a 9% enrollment increase over last year and an average 22% benchmark premium increase; Oregon study finds increased primary care spending in...more
CMS denies Ohio’s Medicaid 1115 waiver request citing the State’s premium proposal; HHS will use 2015 risk corridors collections for remaining 2014 payments; and Alabama closes its Medicaid budget shortfall....more