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!

September 26, 2016

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(1) Republican leaders of the House Energy and Commerce Committee on Sept. 20 urged HHS Sec. Sylvia Burwell to clarify what steps the Obama administration may be taking to settle lawsuits concerning the risk corridors program .... (more)

(2) A decision by a California federal judge on Sept. 19 to certify a class of plaintiffs in two companion lawsuits alleging wrongdoing by United Behavioral Health (UBH), a unit of UnitedHealth Group, could have broad implications for how insurers administer claims in the mental health space under the ERISA statute .... (more)

(3) The U.S. District Court for the District of Columbia denied HHS’s motion to delay until Sept. 30, 2017, proceedings in the case over the backlog of Medicare appeals, but noted the court “does not possess a magic wand that, when waved, will eliminate the backlog." .... (more)

(4) Sen. Bernie Sanders (I-Vt.) and Sen. Elizabeth Warren (D-Mass.), along with Sens. Edward Markey (D-Mass.), Sherrod Brown (D-Ohio) and Bill Nelson (D-Fla.), lambasted Aetna Inc. CEO Mark Bertolini for tying his insurer’s participation in Affordable Care Act (ACA) exchanges to the Dept. of Justice’s (DOJ) approval of Aetna’s deal to buy Humana Inc. Since DOJ sued to deny the merger, Aetna has decided to withdraw from most ACA marketplaces, citing deep financial losses. But the lawmakers said in a Sept. 8 letter to Bertolini that he placed a “dangerous and irresponsible bet” in tying exchange participation to approval of the Humana deal. In response to the letter, Aetna spokesperson TJ Crawford told AIS's Health Plan Week that focusing on Aetna clouds the larger picture. “We are one of many insurers, large and small, that has been forced to reduce its public exchange participation due to an increasingly unstable marketplace. This isn’t a recent development, as more than 40 companies exited certain geographies for the 2016 plan year,” he said. “Singling Aetna out may be politically convenient during election season, but this letter ignores realities and takes the focus away from needed reforms. The ACA is not sustainable without bipartisan action that improves access, affordability and quality of care for consumers.” .... (From Inside Health Insurance Exchanges' E-Alert)

  From Congress and the Federal Agencies

(5) Prices for generic drugs in Medicare Part D declined 59% from first-quarter 2010 to the second quarter of 2015 .... (more)

(6) CMS is suspending the pre-claim review demonstration for home health services .... (more)

(7) Health plan options from at least four carriers will be available throughout Idaho for the 2017 plan year, The Spokesman-Review reported Sept. 20. The board of Idaho’s state-run exchange, Your Health Idaho, approved 225 health and dental insurance plans that will be offered on the exchange in 2017. Residents in all of Idaho’s 44 counties will have at least four health insurance carriers to choose from, if not more, according to the article. The Idaho Department of Insurance will finalize insurance rates this week .... (From Inside Health Insurance Exchanges' E-Alert)


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