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In the states: California OKs CVS-Aetna merger, Michigan gets approval to negotiate Medicaid drug prices, and more

November 16, 2018


American Health Line rounds up the latest health care news in the states.

North Carolina wants to save $300M a year by pegging reimbursement to Medicare rates—but hospitals are pushing back

November 15, 2018


Hospitals in North Carolina are pushing back against a plan to tie what the state pays for workers' health care to Medicare's reimbursement rate—a move that hospitals say could jeopardize access to care.

Meet the lawmakers poised to shape health care in the 116th Congress

November 12, 2018


Prescription drug costs, the Affordable Care Act, and "Medicare-for-All" are among the key policy issues leaders of the 116th Congress likely will address.

93% of participants earned a MIPS bonus payment this year. (But it could be harder next year)

November 9, 2018


Ninety-three percent of clinicians eligible for MACRA's Merit-based Incentive Payment System received a bonus payment for the 2017 performance year, CMS Administrator Seema Verma announced in a blog post.

Mandatory payment models are making a comeback, Azar says

November 9, 2018


HHS Secretary Alex Azar says CMS' Center for Medicare & Medicaid Innovation plans to test a mandatory Medicare payment model for radiation oncology and new versions of two previously canceled payment models for cardiac care.

Congress, divided: What Tuesday's election results mean for health care

November 7, 2018


In Tuesday's midterm elections, Republicans expanded their Senate majority but lost control of the House—likely meaning the GOP effort to repeal the Affordable Care Act is dead, and giving Democrats new leverage to scrutinize President Trump's health policy choices.

Hospital groups will sue to stop Medicare's latest site-neutral payment change

November 5, 2018


Several health care industry groups are pushing back on CMS' plan to implement site-neutral payments in its 2019 Hospital Outpatient Prospective Payment System final rule, and the American Hospital Association and its member hospitals are planning to challenge the change in court.

CMS looks to recoup $1B from MA plans under new proposal

November 5, 2018


CMS is seeking to recoup an estimated $1 billion from Medicare Advantage insurers by 2020 through audits proposed in a rule the agency released late last month.

Judge orders HHS to clear Medicare claims appeals backlog by FY 2022

November 5, 2018


HHS under a recent federal court ruling must meet several milestones to clear the backlog of Medicare claims appeals by the end of fiscal year 2022.

Inside the 2,378-page Medicare Physician Fee Schedule final rule

November 2, 2018


CMS' Medicare Physician Fee Schedule final rule includes changes to evaluation and management visit payments, an initial 3% reduction in Medicare Part B payments for new drugs, new codes to expand providers' telehealth billing options, and more.

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