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Industry News

Jul 09, 2018

More insurers are expected to offer individual health plans on more Affordable Care Act exchanges for 2019. The big question is whether they will just target urban areas or also expand into rural counties, of which more than half have only one carrier.

It seems likely that there will be net gain in participating exchange carriers in 2019, according to a new analysis from the Robert Wood Johnson Foundation. So far there have been no announcements of market exits for 2019, unlike past...

Jul 09, 2018

The Trump administration's latest shock to the Obamacare system by freezing more than $10 billion in 2017 risk-adjustment transfers has even small companies that don't benefit from the program lambasting the CMS.

The risk-adjustment program has long divided insurers, as larger plans with more-sophisticated data teams and a longer history in the market have raked in more money to pay for their higher-cost patients. But even smaller carriers are framing the move as an eleventh-hour,...

Jul 08, 2018
The Trump administration is halting billions of dollars of payments to insurers under the Affordable Care Act's risk-adjustment program, a move that further disrupts the insurance market and could lead to more premium increases next year.

Citing conflicting federal court decisions on the program, the CMS said it cannot collect or disburse funds under the risk-adjustment program. All in all, the program was slated to shift $10.4 billion among insurers in 2017, according to the agency.

Jul 06, 2018

At least two states will push ahead with their programs to impose work requirements on their Medicaid populations despite a federal judge invalidating the CMS' approval of Kentucky's far-reaching waiver last month.

U.S. District Judge James Boasberg in Washington, D.C., held that HHS Secretary Alex Azar did not adequately evaluate whether Kentucky's requirement that expansion enrollees log 80 hours a month of work or community engagement to keep their coverage is consistent with the...

Jul 06, 2018

The Trump administration's decision to rescind some guidance on affirmative action may make it more difficult for medical schools to use race as a factor when making admissions decisions.

U.S. Attorney General Jeff Sessions on July 3 announced plans to pull back a 2011 document—Guidance on the Voluntary Use of Race to Achieve Diversity in Postsecondary Education—that detailed how “postsecondary institutions can voluntarily consider race to further the compelling interest of achieving...

Jul 06, 2018

It's no surprise that labor costs are top of mind for chief financial officers. But with historically low unemployment numbers, that budget line item looms even larger as organizations try to figure out new strategies to not just recruit, but, more importantly, retain workers. CFOs are also central figures in trying to figure out how the industry can become more transparent when it comes to prices. Some make the case that the move to at-risk contracts will greatly alter the debate on...

Jul 06, 2018

Every time a patient doesn't show up or reschedules an appointment, a health system loses money.

That may sound like a minor problem in an industry dogged by astronomically high costs that show little sign of falling, but like an untreated ailment, minor problems often evolve into bigger ones.

Minor problems also tend to be...

Jul 06, 2018
Almost a year ago, the University of Tennessee Medical Center in Knoxville started requiring addicted patients admitted for medical treatment of drug-use associated infections to submit to tough new conduct rules.

They must agree to a search by security, turn over their clothing and all personal property, hand over their cellphone, not leave the hospital floor, and receive no visitors. If they won't sign an agreement to follow those rules, they must leave.

UTMC leaders say the policy...

Jul 06, 2018

Three advocacy groups that won a federal court ruling blocking Kentucky's Medicaid work requirement have asked the CMS to reject the state's move to cut off vision, dental and non-emergency medical transportation benefits in response to the decision.

The National Health Law Program and two other groups sent a letter Friday to the CMS' acting Medicaid director saying Kentucky's proposed state plan amendment to end those benefits was never approved and that the state did not comply...

Jul 06, 2018

For-profit health insurance companies are descending upon Minnesota, where changes in state and federal law have opened up new opportunities for these insurers to stake out a lucrative piece of the industry.

UnitedHealthcare and the Aetna-Allina Health joint venture are both expanding insurance products in the Medicare Advantage and employer markets in Minnesota—a state largely dominated by not-for-profit payers. At least one of them has its eye on the managed Medicaid market as well...