Government News of the Week
Medicare Compliance, HIPAA, Medicare Advantage and Part D,
Health Care Reform, and Other Federal and State Government Developments
Government News of the Week is a weekly email newsletter with timely news stories from Washington, D.C., and the 50 state capitals. Articles are selected for their impact on hospitals, health plans, medical group practices, physicians and other health care providers. Subscribe now to get an issue delivered to your inbox every Monday!

August 24, 2015

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(1) Five years after the Affordable Care Act (ACA) became law, health insurers have adapted to the avalanche of rules and implementation language that came with the statute and grown accustomed to a new world of public exchanges, community rating and scores of other policies .... (more)

(2) President Obama on Aug. 6 signed the Notice of Observation Treatment and Implication for Care Eligibility Act .... (more)

  From the AIS Blogs
  With FDA approval of Praluent, questions remain about new PCSK9 inhibitors. What questions or concerns do you have about this growing category? Join the conversation at the AIS Blogs.

(3) Idaho’s journey in launching a Medicare-Medicaid dual eligibles integration initiative may rival any other state’s in the degree of difficulty it has encountered — and the degree of state-insurer cooperation it has achieved .... (more)

(4) Republican presidential hopeful Wisconsin Gov. Scott Walker on Aug. 18 unveiled a health care reform proposal intended to replace the Affordable Care Act (ACA) if he were to win the White House .... (more)

  From Congress and the Federal Agencies

(5) For the most part, there won’t be any more messing with the rationale for claim denials in the middle of the appeal process. CMS has instructed Medicare administrative contractors (MACs) and qualified independent contractors (QICs) to stick to the reason that the claim was rejected when they are considering appeals of postpayment denials .... (more)

(6) A recent U.S. Government Accountability Office (GAO) review of Medicaid prescription drug claims in four high-spending states concludes that increased reporting on lock-in programs, particularly those for noncontrolled substances, may help strengthen CMS’s efforts to monitor potentially wasteful or abusive practices in the Medicaid program .... (more)

(7) CMS on July 17 suspended enrollment and marketing of two stand-alone Medicare Prescription Drug Plans (PDPs) of Torchmark Corp., saying the company repeatedly failed to meet certain requirements, even after receiving warnings from the agency .... (more)

(8) Along with federal premium tax credits that offset the cost of insurance purchased through a public exchange, some low-income enrollees also are eligible for cost-sharing reductions (CSRs). However, more than 2 million enrollees were unable to take advantage of the program because they chose a non-qualifying plan, according to an analysis released Aug. 19 by Avalere Health LLC. CSRs are available to exchange enrollees who enroll in a silver-tier plan and have an annual income of between 100% and 250% of the federal poverty level ($11,770 to $29,425). According to Avalere, many exchange enrollees selected coverage based on premium costs rather than considering total out-of-pocket costs, which would have been offset by the CSRs. (From Inside Health Insurance Exchanges' E-Alert)

(9) A recent Medicare transmittal (3315) published on Aug. 6 has new and revised place of service (POS) codes for hospital outpatient departments. CMS requires providers to put POS codes on all Medicare claims to report where services are provided .... (more)

(10) The Iowa Dept. of Human Services on Aug. 17 released the names of the winning health insurers to manage the state’s $4.2 billion Medicaid program .... (more)


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