May 23, 2013

Today’s issue is brought to you by AIS's hard-hitting newsletter, Inside Health Insurance Exchanges, containing news and strategic insights on the development and operation of federal, state and private exchanges.

Some States Are Now Sifting Through Carrier Applications for Federally Facilitated Exchanges
Reprinted from Inside Health Insurance Exchanges

May 3 was the application deadline for submitting applications to sell coverage through federally facilitated exchanges. A CMS spokesperson declined to tell AIS how carriers have people applied. .... Read Full Story

From One Extreme to the Other: CBO's MA Projections

It seems that everybody has a theory as to why the Congressional Budget Office (CBO), which in 2010 forecast a drastic decline in Medicare Advantage enrollment stemming largely from provisions of the health reform law, on May 14 issued new projections saying that MA enrollment — and payments to MA plans — will soar by 2023 ... Read more

Tuomey Healthcare System’s alleged violation of the Stark law and false claims submissions, earning them fines in excess of $39 million, “take your breath away…. Tuomey’s Stark position, while aggressive, was not frivolous. This is a potential game changer in terms of the government’s negotiation power and strategy. Unless the Fourth Circuit reverses again, it’s going to be tough for hospitals to litigate another Stark case with this much at stake. Let’s all thank our lucky stars for the CMS self-referral disclosure protocol.”

— Macon, Ga., attorney Alan Rumph told AIS’s Report on Medicare Compliance.

Click here to read the REPORT ON MEDICARE COMPLIANCE article in which this quote appeared. (Free for RMC subscribers; $17 for non-subscribers).

Today's Datapoint

$17 billion … less in penalties will be assessed under the Affordable Care Act because 500,000 to 1 million fewer people will be subject to the individual mandate and fewer business will be hit with penalties for not offering coverage, compared with February estimates, according to a new analysis by the Congressional Budget Office.

Click here to read the AIS's HEALTH REFORM WEEK E-NEWS ALERT in which this datapoint appeared. (Free for HRW subscribers; $17 for non-subscribers).

Partners dominates Massachusetts market due to docs, not hospitals

Partners HealthCare dominates the Massachusetts healthcare market because of its large physician network, as opposed to its number of hospitals, John McDonough wrote in a Health Stew column on Boston.com ... Read more

• Congressional Record
• Federal Register

DxInsights named Ethan Knowlden executive director. Knowlden was vice president of business development and licensing, and corporate counsel for Novartis Vaccines and Diagnostics, Inc....Avalere Health appointed Matthew Eyles executive vice president. Eyles joins Avalere from Coventry Healthcare, where he oversaw government relations and communications.

Content questions or suggestions should be directed to BJ Taylor, editor of AIS's HEALTH BUSINESS DAILY, at bjtaylor@aishealth.com. If you are interested in sponsoring AIS's HEALTH BUSINESS DAILY, please contact Bailey Sterrett at bsterrett@aishealth.com.

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