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!

June 27, 2016

Note: AIS's Government News of the Week will not be published next week. The next issue will be sent on Monday, July 11.

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(1) Led by House Speaker Paul Ryan (R-Wis.), congressional Republicans on June 22 unveiled an Affordable Care Act (ACA) replacement.... (more)

(2) Federal law enforcers filed criminal and civil charges against 301 people, including 30 physicians, in the largest “takedown” in history, the Department of Justice and HHS said at a June 22 press conference.... (more)

  From the AIS Blogs
  When Medicare ACOs and the MSSP were established in 2011, some industry observers predicted a large-scale movement of ACOs building their own risk-bearing entities and forming their own MA plans. But insurers are still primarily working with provider groups to form ACOs that they can use as part of their MA or other products. What do you think will push providers into more risk-based ACO arrangements? Join the conversation at the AIS Blogs.

(3) The House of Representatives on June 21 passed the Small Business Health Care Relief Act (H.R. 5447), which would allow small employers with fewer than 50 full-time employees to avoid fines for reimbursing employee health costs via tax-free Health Reimbursement Arrangements (HRAs).... (more)

(4) CMS on June 21 said it would for the first time target young people who paid the penalty for not having health insurance or claimed an exemption for being uninsured in 2015 as part of its outreach during the 2017 ACA exchange open-enrollment season.... (more)

  From Congress and the Federal Agencies

(5) A bipartisan group of lawmakers on June 14 unveiled a bill aimed at preventing drug companies from staving off generic competition.... (more)

(6) In a preliminary settlement agreement approved by the U.S. District Court for the Southern District of Florida in Ft. Pierce, Fla., Florida Blue agreed to cover the costly hepatitis C drug Harvoni (Gilead Sciences, Inc.) for all of its members... (more)

(7) With the May 31 guidance release of Medicare Part D direct and indirect remuneration (DIR) reporting requirements for 2015, CMS abandoned a proposal that sponsors report the dollar values of certain rebates received from brand-name drug manufacturers. ... (more)

(8) Alabama will implement a rate review program for the first time this year, meaning the state’s only exchange participant, Blue Cross and Blue Shield of Alabama, will have to answer to regulators for premium increases of more than 10%... (more)

(9) Medicare overpaid hospitals $19.6 million over two years for 96 or more consecutive hours of mechanical ventilation... (more)

(10) In its annual June report to Congress, the Medicare Payment Advisory Commission (MedPAC) said risk-based payment models — ACOs, bundles and Medicare Advantage — are the best avenues for Medicare to expand telehealth coverage.... (more)

(11) Horizon Blue Cross Blue Shield of New Jersey has agreed to settle a class-action lawsuit brought forth by chiropractors who contend the insurer systematically denied payment for certain treatments... (more)


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