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Inside the Senate Finance Committee's sweeping new proposal to lower Rx drug costs

July 24, 2019


Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Sen. Ron Wyden (D-Ore.), the ranking member on the committee, on Tuesday introduced a sweeping bill aimed at lowering prescription drug costs by changing various Medicare and Medicaid policies, but the bill quickly drew criticism from congressional Republicans and the pharmaceutical industry.

Why lawmakers keep missing the biggest source of 'surprise' bills

July 24, 2019


At the state and federal levels, lawmakers are considering bills to address so-called "surprise" out-of-network medical bills, but their efforts largely ignore ground ambulances, which are one of the main sources of such bills.

Medicare has overpaid MA insurers billions. Now, CMS wants the payments back.

July 22, 2019


CMS is preparing to move forward with a proposal to use audits to recoup millions of dollars in overpayments to Medicare Advantage insurers, after insurers overcharged Medicare by nearly $30 billion over the past three years.

Fewer ACOS joined MSSP in 2019—but more are taking on risk, data show

July 19, 2019


Fewer accountable care organizations (ACOs) joined the Medicare Shared Savings Program in 2019 than in 2018—but more ACOs are taking on financial risk than in previous years, CMS Administrator Seema Verma announced in a Health Affairs blog published Wednesday.

Unsubsidized premiums rose to record highs in 2019. See the increases, charted.

July 18, 2019


The average monthly health insurance premium for a family of four who did not qualify for subsidies under the Affordable Care Act hit a record high of $1,403 in 2019, according to a new report from the private online health insurance marketplace eHealth.

Senate's 'surprise billing' legislation would save $7.6B over 10 years, CBO predicts

July 18, 2019


The Senate Health, Education, Labor and Pensions Committee's legislative package to address out-of-network "surprise" medical bills would reduce average national provider payment rates by as much as 20%—with much of the effect due to a reduction in in-network payment rates, according to a Congressional Budget Office report released Tuesday.

As CMS tries to expand ACA waivers, Democrats look to scale them back

July 18, 2019


CMS on Monday released new resources for states seeking certain Affordable Care Act waivers, but Democrats have vowed to introduce legislation to roll back the Trump administration's criteria for the waivers after the Government Accountability Office determined Congress has the authority to overturn the guidance.

How WakeMed reduced heart surgery readmission rates by 30%

July 16, 2019


WakeMed Health & Hospitals pioneered the use of Enhanced Recovery After Surgery for heart surgery with dramatic results, seeing intensive care unit stays and readmissions fall and achieving estimated cost savings.

Biden just released his health reform plan. Here's what's inside.

July 15, 2019


Former Vice President Joe Biden, who is seeking the 2020 Democratic nomination for president, today unveiled a health reform plan that aims to build on and protect the Affordable Care Act by providing Americans with the option to enroll in a public health plan and expanding eligibility for subsidies to purchase exchange plans.

Inside the 346-page Home Health Prospective Payment System proposed rule

July 15, 2019


CMS on Thursday released a proposed rule to update certain Medicare payment regulations under the Home Health Prospective Payment System and increase payments for home health agencies by 1.3%.

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