On November 20, 2020, the Centers for Medicare & Medicaid Services’ (CMS) issued a fact sheet and final rule to modernize and clarify regulations that interpret and implement the physician self-referral law. The intent of the final rule is to balance the reduction of unnecessary physician burden with the goal of removing a physician’s financial [...] Read More
Effective January 1, 2019, The Affordable Care Act has required each hospital to publish, update, and make public a list of its standard charges for items and services provided by each hospital; this includes diagnosis related groups (DRGs). In CMS’ 2019 Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) Rule and 2019 […]
Read MoreThis evening, the Department of Health and Human Services (HHS), in conjunction with the Department of the Treasury and the Department of Labor, released two final rules on exemptions and accommodations for the coverage of certain preventive services under the Affordable Care Act (ACA). One final rule covered religious exemptions while the other covered moral [...] Read More
The Centers for Medicare and Medicaid Services (CMS) has released a new guidance for states related to State Innovation Waivers granted under section 1332 of the Affordable Care Act (ACA). With this new guidance, CMS will now refer to these waivers as State Relief and Empowerment Waivers. CMS believes that this new guidance will give [...] Read More
The Centers for Medicare and Medicaid Services (CMS) announced today that the average premiums for second lowest cost silver plans (SLCSP) available on the Exchanges will drop by 1.5% in 2019. This is the first year-to-year drop in average premiums since the Exchanges became operational in 2014. The data released today includes plans sold on [...] Read More
On Thursday, September 6 and Friday, September 7, 2018, the Medicare Payment Advisory Commission (MedPAC) met for its first public meeting of the 2018-2019 cycle. The meeting began with a presentation on the “Context for Medicare payment policy,” intended to orient Commissioners and set the scene for upcoming chapters. The presentation outlined existing and projected [...] Read More
CMS has released the risk adjustment summary report for the 2017 benefit year for the individual and small-group markets. The program, included as a permanent fixture of the Affordable Care Act (ACA), is designed to discourage adverse selection by health plans by providing transfer payments to plans with higher-than-expected health care costs. On a summer […]
Read MoreCMS has announced that the agency will halt payments to health plans under the Affordable Care Act’s risk adjustment program, pending a current court case in New Mexico District Court. The agency was scheduled to disburse $10.4 billion in payments to plans for the 2017 benefit year in the fall. The Saturday afternoon announcement drew […]
Read MoreThe long-awaited association health plan (AHP) final rule answers a lot of questions about what AHPs will have to do, or cover, to pass muster. Namely, they must still charge all participants the same premium, regardless of health status (i.e. community rating), and they cannot bar anyone from joining, or terminate coverage because of health […]
Read MoreThe Department of Health and Human Services (HHS) has responded to comments submitted in 2010 in response to an interim final rule implementing regulations for qualified health plans (QHPs) under the Affordable Care Act (ACA). The response was a requirement of a court case filed by the American College of Emergency Physicians (AECP), and is […]
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