From Health Plan Week - March 4 is the date the Supreme Court has scheduled for oral arguments in the King v. Burwell case, which — depending on who you talk to — could unravel the public exchanges and leave health insurers in a major reshuffle of their individual market strategizing for years to come, if the decision goes against the Obama administration. While a court decision on whether the Affordable Care Act (ACA) allows for subsidies for enrollees on federally facilitated exchanges (FFEs) is not expected until late June, the so-called “tone and tenor” of the oral arguments could have a huge impact, possibly… Read more
From Health Plan Week - Hepatitis C drug Harvoni is on a hot streak as far as winning preferred status on health insurer formularies goes. National plans like UnitedHealth Group and Anthem, Inc. picked the newest hep C entry from Gilead Sciences Inc. over its main competitor from AbbVie Inc. — Viekira Pak — and more recently, Harvard Pilgrim Health Care, Inc. became the first regional plan in New England to sidle up to Gilead… Read more
From Inside Health Insurance Exchanges - If the court rules against HHS in King v. Burwell, some Republican lawmakers will become more vocal about the need to repeal the Affordable Care Act (ACA). But a growing number of conservative lawmakers are likely to pursue a strategy that allows subsidies to remain, in some form, if the Obama administration is willing to remove other provisions, such as the individual and employer mandates, says Stuart Butler, a senior… Read more
From Medicare Advantage News - Nearly half of the entities now operating Medicare Advantage plans are provider-sponsored, and that figure is likely to keep rising, according to a speaker at a Jan. 21 AIS webinar on narrow-network MA plans. But Gary Jacobs, managing director in the Health Industries Advisory practice at PricewaterhouseCoopers and a former top executive at MA insurer Universal American Corp., also said that providers intent on entering MA will need “new competencies”… Read more
From Specialty Pharmacy News - The home infusion industry is hoping that the fifth time’s the charm for bills recently proposed in the U.S. Senate and the House that seek to offer comprehensive Medicare coverage for home infusion. The Medicare Home Infusion Site of Care Act of 2015 seeks to amend the Social Security Act to allow the home to be a covered infusion site of care for Medicare beneficiaries. If passed, it would apply… Read more
From Report on Medicare Compliance - Although encryption of patient data is not a hard and fast regulatory requirement, it’s sneaking in the back door. The HHS Office for Civil Rights is levying fines on health care organizations for lost unencrypted laptops, and encryption of electronic health records must be available to hospitals and physicians for vendors to be certified for stage two of meaningful use. On top of that, the Feb. 6, 2014, HIPAA/CLIA regulation that… Read more
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