From Modern Healthcare

How Congress’ Surprise Billing Compromise Fell Short

December 23, 2019

On the afternoon of Dec. 11, five Democratic leaders in the U.S. House of Representatives huddled to hammer out discord over a surprise billing proposal, just days before a deadline to fund the government.

The spending bill was the best chance lawmakers had to pass surprise billing legislation before the end of the year, as it would insulate them from taking a vote that would divide the powerful corporate interests. But now that prospect was in jeopardy.

On the afternoon of Dec. 11, five Democratic leaders in the U.S. House of Representatives huddled to hammer out discord over a surprise billing proposal, just days before a deadline to fund the government.

The spending bill was the best chance lawmakers had to pass surprise billing legislation before the end of the year, as it would insulate them from taking a vote that would divide the powerful corporate interests. But now that prospect was in jeopardy.

House Speaker Nancy Pelosi (Calif.) and Majority Leader Steny Hoyer (Md.) met with Energy & Commerce Chair Frank Pallone, Ways & Means Chair Richard Neal (Mass.) and Education & Labor Committee Chair Bobby Scott (Va.), and Pelosi gave the committee chairs until 11 a.m. the next day to work out their differences on the measure….

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Politics Threatens Drug Pricing Deal Between Congress, Trump

September 25, 2019

A congressional effort to reach a deal to lower prescription drug prices this year seemed on a path to derailment Wednesday amid political escalation on several fronts.

House Republicans took a hard line against a major plan from House Speaker Nancy Pelosi (D-Calif.), in the first committee hearing on her proposal to authorize government negotiation of certain high-priced drugs.

A congressional effort to reach a deal to lower prescription drug prices this year seemed on a path to derailment Wednesday amid political escalation on several fronts.

House Republicans took a hard line against a major plan from House Speaker Nancy Pelosi (D-Calif.), in the first committee hearing on her proposal to authorize government negotiation of certain high-priced drugs.

Later in the afternoon, Senate Finance Committee Chair Chuck Grassley (R-Iowa) acknowledged his effort with ranking member Sen. Ron Wyden (D-Ore.) to get their embattled proposal on the Senate floor may not happen this year and could slip into early 2020 when when the presidential election will overshadow congressional activity….

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Surprise Medical Bills Becoming More Frequent and Costly

August 12, 2019

Surprise out-of-network billing and related patients’ costs are increasing among inpatient admissions and emergency department visits to in-network hospitals, according to a study published Monday in JAMA Internal Medicine.

Stanford University researchers found that from 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016.

Surprise out-of-network billing and related patients’ costs are increasing among inpatient admissions and emergency department visits to in-network hospitals, according to a study published Monday in JAMA Internal Medicine.

Stanford University researchers found that from 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016.

Out-of-network billing among inpatient admissions to in-network hospitals occurred only slightly less often. Out of 5.5 million admissions, 37% of admissions resulted in at least one out-of-network bill during the entire seven-year period. The frequency increased from 26.3% in 2010 to 42% in 2016, according to the study….

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Centene Nabbed Lower WellCare Price Thanks to Market Downturn

May 28, 2019

A downturn in the market during the fourth quarter of 2018 helped Centene score a better price for WellCare Health Plans, a purchase the companies expect to close in the first half of 2020.

The deal price fluctuated widely over the seven months of negotiations, reaching as high as $380 per share, consisting of as much as 55% cash with the rest being shares of Centene common stock, according to the companies’ joint proxy statement filed last week.

A downturn in the market during the fourth quarter of 2018 helped Centene score a better price for WellCare Health Plans, a purchase the companies expect to close in the first half of 2020.

The deal price fluctuated widely over the seven months of negotiations, reaching as high as $380 per share, consisting of as much as 55% cash with the rest being shares of Centene common stock, according to the companies’ joint proxy statement filed last week.

By the time the companies reached a merger agreement in late March, Centene and WellCare had settled on a lower final price that valued WellCare at about $312 per share and consisted of less cash. The price, which will continue to fluctuate with the market, is made up of $120 in cash and 3.38 Centene shares for each WellCare share. It reflects a premium of about 35% to WellCare’s closing price on March 26, the day the two companies signed the merger agreement….

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Federal Judge Signals Reluctance to Block Short-Term Plans

May 21, 2019

A federal judge on Tuesday indicated he wasn’t willing to block the Trump administration’s rule expanding access to short-term, limited-duration health plans since Congress didn’t limit them in the Affordable Care Act or in the six years after its passage.

U.S. District Judge Richard Leon heard a second round of arguments in the lawsuit over the Trump administration’s reversal of the Obama administration’s cap on short-term plans.

A federal judge on Tuesday indicated he wasn’t willing to block the Trump administration’s rule expanding access to short-term, limited-duration health plans since Congress didn’t limit them in the Affordable Care Act or in the six years after its passage.

U.S. District Judge Richard Leon heard a second round of arguments in the lawsuit over the Trump administration’s reversal of the Obama administration’s cap on short-term plans.

The not-for-profit Association for Community Affiliated Plans first sued to block the rule last year. It was finalized in August and went into effect in early October. In the first set of oral arguments, Leon told the plaintiffs they sought relief prematurely, before they could show proof that the Trump administration’s regulation would deal them a financial blow….

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