HHS Proposes Medicare Home Health Value-Based Purchasing Program


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the Federal Register on July 10, 2015 which would update Medicare payment methods and rates under the home health prospective payment system, update home health quality reporting requirements, and launch the home health value-based purchasing (HH VBP) model beginning in January 2016. [More]


U.S. Supreme Court to hear case next term concerning control of health care data


On Monday, June 29, 2015, the U. S. Supreme Court agreed to hear a case, Gobelle v. Liberty Mutual Insurance Company, in the Court’s next term, as to whether a self-funded insurer should have to turn over certain health related information to the state of Vermont.  [More]


Kaiser report estimates 4.4 percent increase in Exchange premiums for 2016


The Henry J. Kaiser Family Foundation (Kaiser) has released a June 2015 report entitled, “Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s (ACA’s) Health Insurance Marketplaces.”  Kaiser’s report shows that insurer participation in health insurance exchanges (Exchanges) is continuing to grow and that competition among insurers may be helping to contain premiums to about a 4.4 percent increase on average for 2016.  [More]


U.S. Supreme Court upholds Affordable Care Act in KING v. BURWELL by 6 to 3 vote


On Thursday, June 25, 2015, the U. S. Supreme Court by a 6 to 3 vote upheld the federal government’s interpretation (i.e., the regulation of the Internal Revenue Service) of the Affordable Care Act (ACA) that the subsidies awarded under provisions of the ACA could be provided regardless of whether the states granting the subsidies had a state health benefits exchange or a federal exchange operating therein. [More]


CMS has paid out about $1.3 billion to settle Medicare appeals claims


On June 11, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that the agency has settled Medicare appeals claims with more than 1900 hospitals. CMS paid out approximately $1.3 billion pursuant to a settlement policy announced in August 2014 to help reduce a backlog of patient status claim denials pending in the appeals process. [More]

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HHS approves three additional state-based Exchanges


The U.S. Department of Health and Human Services (HHS) notified the Governors of Arkansas, Delaware, and Pennsylvania on June 15, 2015 that HHS has conditionally approved the establishment of state-based health insurance exchanges (Exchanges) by those states. The conditional approvals for Delaware and Pennsylvania are for state-based individual and small business Exchanges in 2016. The conditional approval for Arkansas is for a state-based small business Exchange in 2016 and an individual Exchange in 2017. [More]


Florida legislature reaches agreement on hospital funding for one year


Florida legislators agreed to end a conflict about funding for hospitals for one year by increasing Medicaid reimbursement rates for hospitals. The Low Income Pool program (LIP) funded by a section 1115 project was scheduled to end June 30, but the Center for Medicare and Medicaid Services (CMS) did agree to continue the program at a reduced funding level from $2.2 billion to $1 billion for one year and $600 million thereafter. [More]

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CMS Finalizes New Medicare ACO Rules


The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the June 9, 2015 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Medicare providers and suppliers that participate in a qualifying ACO under the MSSP receive traditional Medicare Part A and Part B fee-for-service payments but the ACO has an opportunity to earn “shared savings” bonus payments if it achieves MSSP savings targets and quality benchmarks. [More]


White House Releases Report on Benefits of Medicaid Expansion


The White House has released a report entitled, “Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid.” The report estimates that if the 22 states that have not yet expanded Medicaid chose to do so, some 4,299,000 persons in those states would gain coverage; 1,021,000 more persons would report a usual source of care; 491,000 more persons would receive all needed care; hundreds of thousands more persons would receive recommended preventive screenings (626,400 more persons would receive cholesterol screenings, 163,400 more women would receive mammograms, etc.); [More]


U.S. Supreme Court rejects Maine’s attempt to end Medicaid coverage for young adults


On Monday, June 8, 2015, the U.S. Supreme Court refused to review a decision by the First Circuit Court of Appeals, which upheld a decision by the Centers for Medicare & Medicaid Services (CMS) rejecting a plan by Mary Mayhew, Maine’s top health official, to cease Medicaid coverage for 6000 19- and 20-year-olds. [More]