Oct 29, 2018 | Legislation/ Budgets/ Macro, Medicare
The Office of Information and Regulatory Affairs recently released the Administration’s Unified Agenda of Regulatory and Deregulatory Actions, which reflects agencies’ foci. We compiled a list of key items in the healthcare space by date of anticipated rule release. Click to read more.
Oct 26, 2018 | Managed Care Friday
1. 380,000: The number of premature births a year or about 10% of the US births, according to a Cigna source we interviewed who says the managed care plan is improving coverage and reimbursement for ultrasonagraphy in the first trimester, particularly for those women unclear about the timing of their menstrual cycle. 2. AIM Higher, Radiation: In 2019, new approval rules will take effect for radiation oncology, and most ease some of the existing requirements, which would be a plus for providers in states where Anthem is the major payer. AIM, the Anthem company that determines clinical...
Oct 19, 2018 | Managed Care Friday
Extra Point Managed care plans and healthcare providers have been struggling of late to make value-based payments work, but this may be changing. Payers in more than 6 states serving Medicaid patients are now being told from the state that 25% of their premium must be spent on value and, under contracts with the state, 33% up to 50% in the near future, our sources say. But this isn’t so clear to define. Thankfully, a few of the MCOs, and a few in other managed Medicaid states we’ve interviewed, say they think the states will give them ‘wiggle room’ to define value on their terms. One...
Oct 18, 2018 | Legislation/ Budgets/ Macro, Medicaid
CMS announced this week that Mary Mayhew will serve as the new deputy administrator and director of the Center for Medicaid and CHIP Services, after Brian Neale resigned from the position in January. Mayhew was most recently Maine Governor Paul LePage's top health official and an opponent of Medicaid. Also, the GAO released a study finding that, relative to expansion states, non-expansion states have a greater number of uninsured low-income adults overall, with unmet medical needs, with financial barriers to medical care, and without a usual place of care. Click to read more.
