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!

May 18, 2015

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(1) America’s Health Insurance Plans (AHIP) in a May 12 blog post advocates for the passage of legislation to allow states to maintain their current definitions for small-group marketplaces .... (more)

(2) Guidance on the 340B program is at the Office of Management and Budget (OMB). The move follows the HHS Health Resources and Services Administration’s submission of a so-called .... (more)

  From the AIS Blogs
  Do you think the Medicare Part D program needs additional protection from drug price inflation? Join the conversation at the AIS Blogs.

(3) A Pennsylvania man who was kicked out of Medicare in 2002 allegedly orchestrated the formation of a new company to provide diabetic services and supplies to nursing facility residents in his wife’s name .... (more)

(4) The U.S. Supreme Court declined to hear Bristol-Myers Squibb Co.’s appeal of a patent protection ruling on its hepatitis B treatment Baraclude (entecavir), according to various news sites .... (more)

  From Congress and the Federal Agencies

(5) The assessment on qualified health plans (QHPs) sold through Colorado’s state-based exchange could more than double from 1.4% to at least 3.5% of premiums, The Denver Post reported May 11. Connect for Health Colorado’s leaders recommended the increase to help the entity become self-sustaining now that federal funding has run out. The Affordable Care Act requires state-based exchanges to be self-sustaining as of Jan. 1, 2015. The estimated annual increase in revenue for the exchange would be about $5.8 million, according to the article. Exchange leaders also recommended that the board of directors boost the monthly assessment the exchange charges for each private insurance policy purchased on or off the exchange from $1.25 to $1.80. The assessment, unless extended by legislators, ends next year. It applies to 1.2 million insurance policies statewide in a calendar year.(From Inside Health Insurance Exchanges' E-Alert)

(6) HHS, along with the Labor and Treasury departments, on May 11 informed health insurers in new guidance that it is their responsibility, along with group health plans, to cover a complete suite of contraceptives and other preventive services, and make at least one choice for every form of prescription birth control free .... (more)

(7) Billing compliance lapses around place-of-service codes have reared their heads again in a new audit. The HHS Office of Inspector General (OIG) says Medicare contractors possibly overpaid physicians about $33.4 million for incorrectly coded services provided between January 2010 and September 2012 .... (more)

(8) The California Dept. of Managed Health Care will hold a public hearing on June 8 to air concerns about Blue Shield of California’s planned $1.25 billion purchase of Medicaid insurer .... (more)

(9) Due to a budget-neutrality requirement, the Affordable Care Act’s (ACA) risk corridor program will likely be “significantly underfunded,” according to an analysis from ratings firm Standard & Poor’s .... (more)

(10) The General Accountability Office (GAO) on May 13 said HHS lacks transparency in how it decides on Medicaid program waivers for states under the so-called 1115 waiver protocol .... (more)

(11) Unless it receives a sudden and substantial cash infusion, Hawaii’s insurance exchange will need to shut down and transfer its functions to the state legislature, which recently approved $2 million for the Hawaii Health Connector. That amount is far short of the $10 million the exchange’s leaders requested to ensure the entity’s sustainability, Pacific Business News reported May 11. The Connector has prepared a contingency plan to close operations by the end of the third quarter. The plan calls for halting new enrollments on Friday, May 15, transferring the technology to the state on Sept. 30 and eliminating the exchange’s more than 60 full- and part-time workers, as well as a dozen contractors, by Feb. 28, 2016.(From Inside Health Insurance Exchanges' E-Alert)


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