Strategic Restructuring for the Future - Think Before You Sign: Five Key Insights for VBID and Managed Care Contracts
Part Two: The MFN Drug Pricing Rule and the Rebate Rule: Where Do We Go From Here?
Part One: Two new Medicare Drug Pricing Rules in One Day: What are the MFN and the Rebate Drug Pricing Rules?
Health Care Enforcement: The Impact on Private Equity Investments
Why Health Care Providers Need A Managed Care Strategy
Editor’s Note: There is mounting evidence that addressing the social and economic factors that drive the majority of health outcomes, often called social drivers of health (DOH), can improve health, promote health equity and...more
UPDATED: It’s out! The much anticipated guidance, entitled the “Healthy Adult Opportunity” (HAO), from CMS introducing ways to revamp Medicaid financing has been out for nearly a week and we have had some time to review the...more
CMS releases a wave of new regulations and guidance for Medicaid and CHIP; Michigan receives CMS approval for a lead abatement initiative; and Utah continues to push for its limited expansion of Medicaid coverage....more
CMS targets Medicaid managed care pass-through payments; California proposes “California Qualified Health Plans” for the undocumented; and a new study finds out-of-pocket costs were reduced by nearly a third for Medicaid...more
Oregon decides to stick with HealthCare.gov’s enrollment platform; North Dakota re-examines Medicaid expansion as 2017 sunset approaches; and Vermont establishes a special enrollment period for pregnancy....more
South Dakota expects additional $18 million in Medicaid expansion savings due to CMS's revised IHS rules; Arizona uses procedural maneuvers to reinstate enrollment in CHIP; and comprehensive Medicaid managed care enrollment...more
Rhode Island's Medicaid reforms will save the State $75 million this year; HHS finds that Medicaid expansion improves behavioral healthcare; and California's Marketplace may exclude poor performing hospitals from its QHP...more
STATE STAFFING UPDATES: Nevada: New Insurance Commissioner Appointed - The Director of Nevada's Department and Industry announced Barbara Richardson as the Commissioner of the Division of Insurance. Richardson...more
Medicaid continues to gain scale and importance nationally – as both the leading source of health coverage for Americans, and as a change agent within the healthcare marketplace. With the number of Americans obtaining...more
Louisiana's Governor signs an executive order on his first day in office to expand Medicaid; Kentucky's Governor opts to replace, rather than repeal, its Medicaid expansion program; and New York and Missouri make it easier...more
Guidance from HHS and Treasury sets a high bar for 1332 waiver approvals; Kentuckians support Medicaid expansion and their State Marketplace despite plans to change course; and South Dakota's executive budget includes funds...more
Kansas legislators supportive of Medicaid expansion are pulled from committee; Montana’s Medicaid expansion is off to a strong start; and New Mexico sees declines in uncompensated care since ACA implementation....more
Iowa's largest insurer joins the State's Marketplace for coverage year 2017; carrier changes are announced for Marketplaces in Kentucky, Oklahoma and Wyoming; and South Dakota's Governor convenes the Health Care Solutions...more
The Massachusetts Marketplace takes steps to ease consumer confusion by reducing choice among QHPs; North Carolina appears poised to pass Medicaid reform legislation; and bipartisan support is gaining for defining businesses...more
In the wake of the implementation of the Affordable Care Act, the recent Medicare Managed Care Proposed Rule (the Proposed Rule) exemplifies the accelerated push by the Department of Health and Human Services and Centers for...more
Managed care is the dominant delivery model in state Medicaid programs, and is rapidly growing with the Affordable Care Act bringing over 8 million new beneficiaries into Medicaid in 2014. Today, 39 states (including the...more
This week, the IRS announces relief for some taxpayers who received excess advanced premium tax credits; Indiana and Arkansas make major announcements on Medicaid expansion and Iowa’s Governor announces a shift towards...more