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!

February 1, 2016

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(1) Centene Corp. on Jan. 25 said it is conducting an “internal search” for six missing hard drives containing personal health information of some 950,000 members who received laboratory services from 2009 to 2015 .... (more)

(2) Connecticut’s state-run insurance exchange intends to more thoroughly verify eligibility of people who sign up for health coverage outside of the traditional open-enrollment period, which concludes Jan. 31, The Connecticut Mirror reported Jan. 21. People who cite “life changes” such as a permanent move, divorce or loss of a job are able to purchase coverage through a special enrollment period (SEP). Access Health CT previously has not required proof that applicants qualify for a SEP. A survey of Connecticut insurers by Wakely Consulting Group and presented to the exchange’s board found that people who signed up during SEPs had significantly higher health care costs and were more likely to drop coverage within three months of getting it compared with those who enrolled during the regular period, the newspaper reported. CMS allows 33 SEPs for the public exchanges, compared to just seven for Medicare Advantage (MA) plans .... (From Inside Health Insurance Exchanges' E-Alert)

  From the AIS Blogs
  The devil will be in the details of the ban on new off-campus provider-based departments. Join the conversation at the AIS Blogs.

(3) The Medicare Payment Advisory Commission (MedPAC) on Jan. 14 overwhelmingly adopted a staff proposal that would exclude for Medicare Advantage risk-adjusted payment purposes diagnoses obtained just from health risk adjustments (HRAs) without any evidence of clinical follow-up .... (more)

(4) If patients get stuck in hospitals for two midnights or more because of historic blizzards like Jonas, which pummeled the East Coast and mid-Atlantic in late January, hospitals can’t bill Medicare Part A, .... (more)

  From Congress and the Federal Agencies

(5) California’s four largest carriers — Anthem Blue Cross, Blue Shield of California, Health Net, Inc. and Kaiser Permanente — are fighting lawsuits that could force them to pay back taxes of some $10 billion combined because of the way the carriers are classified for tax purposes .... (more)

(6) The former president of a compounding pharmacy and its former pharmacist in charge were charged with crimes in connection with adulterated drugs that sickened patients at various Birmingham, Ala.-area hospitals in 2011 .... (more)

(7) In its voluminous 2016-2026 budget outlook released on Jan. 25, the Congressional Budget Office (CBO) said it was off 40% from its earlier projections for Affordable Care Act (ACA) public exchange enrollees .... (more)

(8) CMS on Jan. 21 temporarily halted new enrollment in and marketing for Medicare Advantage and stand-alone Medicare Prescription Drug Plan (PDP) products of Cigna Corp. following an October audit .... (more)

(9) The Affordable Care Act helped streamline and upgrade Medicaid and Children’s Health Insurance Program (CHIP) enrollment processes .... (more)

(10) CMS will not shed any more light on the ban on new off-campus provider-based space until the proposed 2017 outpatient prospective payment system (OPPS) regulation .... (more)

(11) Top-polling Republican presidential candidate Donald Trump broke with his party’s traditional stance during a campaign stop in New Hampshire on Jan. 25, saying he would like to see the Medicare program be given the power to negotiate prescription drug prices with pharmaceutical manufacturers .... (more)


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