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 25, 2015

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(1) In an effort to clear up some residual ambiguity around health reform-mandated coverage of contraceptives and other preventive services, HHS and the Departments of Labor and Treasury on May 11 issued new guidance outlining the methods that must be covered and the exceptions process that plans must have in place to accommodate nonpreferred agents deemed medically necessary by a health care provider .... (more)

(2) The former assistant administrator of a Houston hospital was sentenced to 40 years in prison in connection with a $116 million Medicare fraud scheme .... (more)

  From the AIS Blogs
  Registrants who listened to the session of CMS’s annual spring MA and Part D conference with the nondescript title of “Network Management Module” found out that CMS intends to start using in late summer a “more robust version” of the already-existing NMM to evaluate MA provider-network access at any time during the year. What do you think of CMS’s approach on the issue — and on the way it was disclosed to the industry? Join the conversation at the AIS Blogs.

(3) Missouri Gov. Jay Nixon (D) on May 19 said the state and Aetna Inc. reached a $4.5 million settlement related to the insurer’s failure to provide coverage for the diagnosis and treatment of autism spectrum disorders .... (more)

(4) State health officials will review Blue Shield of California’s proposed $1.25 billion acquisition of Care1st Health Plan on June 8 .... (more)

  From Congress and the Federal Agencies

(5) Two U.S. senators have asked HHS Secretary Sylvia Burwell to submit a list of all “interpretive rules,” also known as “non-legislative rules,” issued since July 24, 2007, and a list of guidance in draft form .... (more)

(6) St. Anthony’s Medical Center in St. Louis was overpaid $308,853, according to a Medicare compliance review (A-07-14-05059) of 262 claims submitted in 2011 and 2012 .... (more)

(7) Medicare Advantage enrollment increased by 29,985 as of the May 1 payment date, reflecting enrollments through April 10, from the previous month’s level, according to data CMS released in mid-May .... (more)

(8) The ERISA Industry Committee (ERIC) on May 15 petitioned the IRS to amend provisions of the so-called Cadillac tax set to go into effect in 2018 .... (more)

(9) Shima Andre, a member of Anthem Blue Cross, the California unit of Anthem, Inc., on May 15 filed a lawsuit alleging that the insurer refused to pay the estimated $99,000 cost for Gilead Sciences Inc.’s hepatitis C drug Harvoni .... (more)


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