From Health Plan Week - An earlier version of this story incorrectly said that GNS Healthcare’s software products build care management plans. The software products predict individual risk, causes of risk, and intervention value. It also stated incorrectly that GNS partnered with Aetna and Newtopia in 2012. GNS partnered with Aetna in 2012. Aetna later partnered with Newtopia and published the results in the Journal of Occupational and Environmental Medicine. This version has been corrected. Read more
From Health Plan Week - Private exchanges may see more modest enrollment growth for 2016 because of the two-year delay in the implementation of the excise or Cadillac tax on high-cost health plans from an initial start date of 2018 to the new kickoff in 2020. But private exchange market consultants say the rise in employers interested in switching to a private exchange to deliver health benefits in a defined-contribution mode will march on regardless. Read more
From Inside Health Insurance Exchanges - Based on recent proposals from CMS, the agency in 2017 intends to take on a bigger regulatory role in reviewing premium rates and categorizing provider networks for qualified health plans (QHPs) offered via the 36 insurance exchanges that rely on the federal platform. Two days before Christmas, CMS issued its fourth annual draft Letter to Issuers that participate in the federally facilitated exchanges (FFEs). Read more
From Medicare Advantage News - Medicaid managed care’s penetration rate might grow by even more in 2016 than in 2015 as additional state programs kick in, industry executives and observers predict. And long-term services and supports will become a key part of numerous additional Medicaid programs this year as states increasingly conclude that LTSS is necessary for meeting care-integration and cost-reduction goals. But the startup processes won’t be all smooth, as recent developments in states… Read more
From Drug Benefit News - While the workers’ compensation industry is working to tackle opioid misuse and abuse by effecting change at the state level (see story, p. 1), the Centers for Disease Control and Prevention (CDC) has posted a long-awaited set of prescribing guidelines that address, among other things, the use of opioids for chronic pain outside end-of-life care and opioid selection and dosage. Read more
From Report on Medicare Compliance - Jupiter Imaging Associates in Florida has settled allegations with the HHS Office of Inspector General (OIG) that it gave gift cards to 100 referring physicians, with the value of the cards based on the volume of the physician’s referrals. Jupiter, which provides diagnostic radiology services, allegedly violated the civil monetary penalty (CMP) law applicable to physician self-referrals and kickbacks, OIG said. Read more
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