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CMS wants ACOs to take on more risk. Here's how.

August 13, 2018


CMS is proposing replacing the current Medicare Shared Savings Program tracks with two options that accelerate the pathway for accountable care organizations to transition to two-sided risk models.

CMS will allow MA plans to implement step-therapy requirements for Part B drugs

August 13, 2018


Under a new CMS policy, Medicare Advantage plans beginning Jan. 1, 2019, will be able to implement step-therapy requirements for prescription drugs administered to beneficiaries at physician offices or hospitals—and President Trump says his administration soon will announce more policies intended to lower prescription drug prices.

CMS proposes methodology to calculate exchange insurers' 2018 risk-adjustment payments

August 13, 2018


CMS says under a newly proposed rule it intends "to adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year which uses the statewide average premium in the payment transfer formula."

HHS announces recipients of Title X family planning grants

August 13, 2018


HHS says that it will award about $290 million in Title X family planning grants to all current grantees and 12 new organizations—including groups that are suing HHS over its new criteria for organizations seeking the grants.

Payment bumps and price transparency requirements: Inside CMS' 2,610-page IPPS final rule

August 3, 2018


CMS' final rule for the Inpatient Prospective Payment System and Long-Term Acute Care Hospital (LTCH) Payment System for fiscal year 2019, which overhauls the meaningful use program and aims to improve hospital price transparency, will affect about 3,300 acute care facilities and about 420 LTCH facilities.

Some insurers are planning to lower their premium rates for 2019

August 3, 2018


Insurers in many states are seeking single-digit premium rate increases for health plans sold on the Affordable Care Act's exchanges—and some are even seeking premium decreases, marking a significant change from several years of double-digit rate increases.

Senate Democrats want to rescind Trump's short-term health plan rule. Here's their plan.

August 3, 2018


Senate Democrats plan to introduce a resolution of disapproval that would repeal the Trump administration's final rule on short-term health plans, which they argue "would raise premiums and reduce plan choices for individuals with pre-existing conditions."

FDA issues guidance to close orphan drug loophole

August 3, 2018


FDA in final guidance aims to close a regulatory loophole that the agency says allowed some drugmakers to receive an orphan drug designation for drugs that treat diseases that affect fewer than 200,000 pediatric patients without conducting research on how the drugs work in pediatric populations.

Lawsuit claims Trump admin is violating Constitution by 'undermining' ACA

August 2, 2018


Four cities in a lawsuit claim that President Trump and his administration are violating the Constitution by not ensuring the Affordable Care Act is "faithfully executed."

CMS finalizes payments bump for post-acute care, hospice providers

August 2, 2018


CMS' final rules for skilled nursing facilities, inpatient rehabilitation facilities, and inpatient psychiatric facilities will increase payments to the facilities by a total of $975 million for fiscal year (FY) 2019, while a separate final rule will increase Medicare payments for hospices by a total of $350 million for FY 2019.

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