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!

April 27, 2015

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(1) On April 17 CMS released the proposed 2016 inpatient prospective payment system regulation and long-term care hospital payment regulation .... (more)

(2) CMS on April 22 issued new guidance for 2016 public exchange eligibility redeterminations and re-enrollments .... (more)

  From the AIS Blogs
  There are legal and public-relations skirmishes between major corporations every day, but there is nothing quite like a UPMC-Highmark Inc. battle to move the level of the rhetoric to that of good, old-fashioned street fights. We got another taste of this within the past week and a half when the two western Pennsylvania health care giants lifted the curtain on the newest developments in their long-simmering dispute over the level of payments UPMC gets for Highmark’s MA beneficiary cancer care at UPMC hospital-affiliated facilities. Join the conversation at the AIS Blogs.

(3) State surveyors will exclude observation beds when determining whether critical access hospitals fall within the 25-bed maximum allowed by the Medicare conditions of participation, according to Transmittal 138, which revised the state operations manual .... (more)

(4) Reps. Pat Tiberi (R-Ohio) and Daniel Lipinksi (D-Ill.) have re-introduced legislation to repeal the ACA’s reinsurance fee .... (more)

  From Congress and the Federal Agencies

(5) As of April 13, more than 68,000 people had taken advantage of a special enrollment period (SEP) created for taxpayers who owed a penalty for not having health insurance in 2014, CMS reported April 20. The enrollment, which is substantially lower than many industry observers had predicted, doesn’t include people who purchased coverage through a SEP offered by a state-based exchange.’s SEP runs until the end of April. The penalty for those who remain uninsured in 2015 will increase to 2% of household income or $325 per person, whichever is greater.  (From Inside Health Insurance Exchanges' E-Alert)

(6) A hospital manager who was arrested in March for mail and wire fraud after an investigation set in motion by an anonymous tip to the chief compliance officer has pleaded guilty .... (more)

(7) The Department of Justice said on April 21 it has intervened in three false claims lawsuits against HCR ManorCare, which operates 281 skilled nursing facilities (SNFs) in 30 states .... (more)

(8) Family Dermatology, P.C., agreed to pay $3.24 million to settle false claims allegations around improper financial relationships with some of its physicians .... (more)

(9) Sen. Ron Johnson (R-Wis.) introduced legislation on April 21 that is meant to be a contingency plan for public exchange enrollees if they lose federal subsidies due to a Supreme Court decision striking down the payments .... (more)

(10) Medicare Advantage enrollment increased by 31,598 as of the April 1 payment date, reflecting enrollments through March 13, from the previous month’s level .... (more)

(11) Ben-E-Lect is suing Anthem, Inc. for refusing to do business with insurance brokers who sell less expensive plans in California .... (more)

(12) Kentucky is rebidding its Medicaid managed care contracts instead of renewing the current contracts for another year .... (more)

(13) In an April 2 letter, CMS imposed a $1 million fine on Aetna “as a direct consequence” of the inaccurate pharmacy network information posted by the Medicare Part D plan sponsor to its website and provided through its call center customer service representatives that led to confusion .... (more)

(14) Two states in April took steps to increase the timeliness of PBM updates to maximum allowable cost (MAC) lists .... (more)


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