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 23, 2016

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(1) On May 16, the Equal Employment Opportunity Commission (EEOC) unveiled two final rules affecting how employers’ wellness programs coexist with anti-discrimination statutes .... (more)

(2) A bill to modify Sec. 603 of the Balanced Budget Act of 2015, which put an end to new off-campus provider-based space, was introduced on May 18 by Sen. Pat Tiberi (R-Ohio), chairman of the House Ways and Means Committee’s Health Subcommittee, and Sen. Jim McDermott (D-Wash.), its ranking member .... (more)

(3) Express Scripts Holding Co. on May 9 petitioned a U.S. district court to dismiss claims brought by a group of compounding pharmacies that the PBM has engaged in antitrust practices .... (more)

(4) Health plan operators that intend to sell individual coverage in Washington state this fall have proposed an average rate increase of 13.5%, the Office of the Commissioner of Insurance reported May 16. Thirteen carriers collectively filed 154 individual health plans for 2017 coverage to be sold inside and outside of the Washington Healthplanfinder exchange. Nine of the 13 insurers intend to sell individual plans inside the exchange, and four will sell only outside of it. Premera Blue Cross, which seeks to sell coverage only outside of the exchange, asked to boost its rates by 20%. Coordinated Care, a subsidiary of Centene Corp., is seeking the lowest percentage increase at 7.4%. UnitedHealthcare of Washington will leave the state’s individual market in 2017, and Moda withdrew in January. Both insurers sold plans statewide. Two other statewide insurers, Premera and Lifewise, intend to stop marketing outside of the exchange and will reduce the number of counties where they will offer plans, according to the state’s insurance commissioner .... (From Inside Health Insurance Exchanges' E-Alert)

  From Congress and the Federal Agencies

(5) The California Public Employees’ Retirement System (CalPERS) on May 18 said it selected UnitedHealth Group’s OptumRx as its new PBM under a five-year contract valued at $4.9 billion .... (more)

(6) In its latest effort to fine-tune and improve the Coordinated Care Initiative, the California Dept. of Health Care Services on May 5 said it will no longer automatically enroll low-income elderly and disabled residents in managed care plans in favor of a streamlined “opt-in” enrollment strategy .... (more)

(7) B. Braun Medical Inc., a medical device and drug company, agreed to pay $4.8 million to resolve criminal liability and as much as $3 million in restitution for selling contaminated pre-filled saline flush syringes in 2007 .... (more)

(8) The California Department of Managed Health Care (DMHC) recently issued a $415,000 fine against Anthem, Inc.’s Anthem Blue Cross for mishandling enrollee grievances .... (more)

(9) The five regional managed care organizations awarded contracts late last month by the Pennsylvania Dept. of Human Services (DHS) to serve the state’s newly revamped managed Medicaid program are AmeriHealth Caritas, Gateway Health Plan, Geisinger Health Plan, Health Partners Plans and UPMC Health Plan .... (more)

(10) A group of shareholders on May 4 filed a proposed class-action lawsuit (No. 1:16-cv-03338) against Express Scripts, alleging the PBM hid the severity of its disagreement with Anthem, Inc .... (more)

(11) Lafayette General Medical Center in Louisiana was overpaid $4.4 million, according to a Medicare compliance review .... (more)


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