The Biggest Obstacle to Value-Based Care
KCP supports House bill to restore original intent of Medicare Secondary Payer Act - Kidney Care Partners (KCP) commends the 36 co-sponsors of the bill before the House, who come from both sides of the aisle and represent...more
On 17 January 2024, the Centers for Medicare & Medicaid Services (CMS) released a final rule outlining new interoperability and prior authorization requirements for certain payors (Final Rule). With the adoption of the Final...more
On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website), which aims to improve prior...more
As the United States continues to grapple with a growing mental health crisis, millions are finding it increasingly difficult to access and afford mental health treatment. Recent investigations conducted by the New York...more
INTRODUCTION - On 13 December 2022, the Centers for Medicare and Medicaid Services (CMS) published CMS-0057-P (the Rule),1 a proposed rule that, if adopted, will place new requirements on a number of entities, including...more
On December 28, 2021, HHS released a proposed rule governing plans issued in the Patient Protection and Affordable Care Act (ACA) marketplaces beginning with the 2023 plan year (the Proposed Rule). Among other changes to the...more
After a six-month delay due to the COVID-19 pandemic, the first provisions of the interoperability rule issued by the Centers for Medicare & Medicaid Services (CMS) took effect on July 1. The new requirements are the first of...more
Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in healthcare regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and...more
A recent case in the Northern District of California presents a reminder that hospital systems need to consider antitrust issues when negotiating multi-hospital contracts with health plans. Unfortunately, even when hospitals...more
The Centers for Medicare & Medicaid Services (CMS) issued FAQ guidance encouraging health insurers to relax their utilization management and prior authorization requirements in view of the COVID-19 pandemic while at the same...more
The Centers for Medicare & Medicaid Services (CMS) published its highly anticipated final rule aimed at enhancing interoperability and increasing patient access to health information. CMS’s final rule will require hospitals...more
California Attorney General Xavier Becerra (AG Becerra) announced on Friday, December 20, 2019, the terms of a comprehensive settlement agreement reached with Sutter Health (Sutter), the largest hospital system in Northern...more
On October 11, 2019, California Governor Gavin Newsom signed a new law requiring commercial health insurance coverage and payment parity for telehealth services. The law will benefit patients by increasing access and...more
CMS issued a long-awaited proposed rule aimed at enhancing interoperability and increasing patient access to health information. If finalized, CMS’s proposed rule may require hospitals and payors to make significant...more
On January 24, 2019, CMS published its annual Notice of Benefit and Payment Parameters for 2020 ("Proposed 2020 Payment Notice") proposing parameters applicable to qualified health plans (QHPs) on the Exchanges for plan years...more
Q: Mr. Keane, could you please share with us a little bit about your background and about Unity Health Care, the organization you lead? A: Unity Health Care is a §501(c)(3) federally qualified health center (FQHC) located...more
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
The Agency of Transportation has submitted a proposal to the House Transportation Committee that would allow the agency to seek damages from a utility that fails to move or adjust a utility line that is in a state or local...more
This Week: Congress remains in recess, but members write letters on Mylan’s EpiPen…CBO says repealing Part B Demo would cost $395 million…CMS releases data on hospice utilization and finds spending and utilization vary in...more
Study finds that Marketplace premiums are lower than employer-based premiums, even without federal subsidies; New York regulators move to shield insurers from outsized federal risk adjustment payments; and Missouri will seek...more
I. REGULATIONS, NOTICES, & GUIDANCE - On April 4, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the Final Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage (MA) and...more
Just as the Centers for Medicare & Medicaid Services (CMS) began holding federal health care plans accountable for their provider network transparency obligations, the New Jersey legislature stalled in its bid to pass a law...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
Congress passes a bill to give states greater flexibility in defining “small businesses”; South Dakota seeks to offset Medicaid expansion costs in part with increased use of the fully federally-funded Indian Health Service;...more
Colorado’s uninsured rate is down 9 percentage points in four years; Michigan requests increased cost-sharing for its Medicaid expansion population above the federal poverty line; and, HHS’s proposed guidance strengthens...more