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 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. [This shows the ineffectiveness of patchwork legislative solutions since Obamacare contained provisions to stop surprise bills when it passed in 2010.]
Consolidation in the health system and health insurance industries has been a focus for years. But a new report sheds light on how the “bigger is better” mantra has taken hold in companies that make syringes, X-ray machines or other healthcare products
The report, prepared by the Open Markets Institute using data from IBISWorld, shows a small handful of companies dominate their respective markets in certain healthcare sectors that tend to get less of a spotlight than their payer and provider counterparts.
The Centers for Medicare & Medicaid Services will take more time to judge the performance of navigator groups tasked with ACA enrollment outreach, the agency said Thursday. Performance is tied to funding. Starting in the 2020 open-enrollment period, navigator groups will be evaluated on a two-year performance period rather than one year. Federal funding is tied to how many people are signed up by the groups. The CMS said the change will help stabilize the program and improve consumers’ experience.
Kansas’ new law allowing the sale of health plans that can turn away people with pre-existing medical conditions has heightened concerns that more states may move to allow leaner, cheaper plans that don’t comply with ACA rules. So far, three states have passed laws allowing their Farm Bureaus to bypass ACA rules and sell health plans that are free from any state insurance regulation. Kansas became the latest last week. The state’s Democratic governor let the bill become law without her signature in the hope of winning GOP support for a bill to expand Medicaid to low-income adults, though that remains uncertain.
The CMS is inviting state Medicaid agencies to pursue new ways of integrating care for patients eligible for both Medicare and Medicaid—a population that has complex health needs and accounts for a big portion of spending in both public health programs. In a letter to state Medicaid directors, CMS Administrator Seema Verma described three new ways states can test approaches to integrating care for dual-eligible patients with the goal of improving the quality of their care and reducing costs for federal and state governments. “Less than 10% of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems,” Verma said. “This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all.”
A federal judge on Thursday rejected the Trump administration’s attempts to expand access to association health plan. U.S. District Judge John Bates in Washington said the administration’s final rule allowing associations and employers to band together to create AHPs goes beyond its authority under the Employee Retirement Income Security Act (ERISA). The Trump administration’s rule allows employers to join together to gain more efficiencies of scale in purchasing coverage and services, and the plans are more affordable because they don’t have to follow many ACA rules.
The CMS rolled out new tools on Thursday to help states get approval to make changes to Medicaid such as implementing work requirements.
The CMS Administrator Seema Verma defended the administration’s push to get more states to pursue 1115 demonstration waivers even as the agency faces criticism over coverage losses due to work rules.
|The CMS is asking the public for ideas and advice on how to make it easier for health insurers to sell policies across state lines. The agency issued a request for information on Wednesday for recommendations on eliminating barriers and enhancing insurers’ ability to sell individual insurance coverage from state-to-state. The request, which the CMS said is meant to promote competition and choice for consumers, follows President Trump’s October 2017 executive order on cost and competition in the health sector. CMS said it is interested in feedback about how states could use Section 1333 of the ACA, which allows insurers to enter into a “healthcare choice compact,” to sell out-of-state coverage if state regulators agree.
The Trump administration wants to know what challenges employer and group health plans face in maintaining grandfathered status for Affordable Care Act plans.
The Treasury and Labor departments and HHS issued the request for informationlate Thursday. The request comes as the number of grandfathered plans fall.
The agencies want to understand “whether there are opportunities for the departments to assist such plans and issuers,” the rule said.
The Utah Legislature on Monday passed a bill to replace the voter-approved Medicaid expansion with a skinny expansion, a move that may encourage other states to seek similar scaled-back expansions with full federal funding.
The Republican-controlled Utah Senate approved legislation passed by the state House of Representatives Friday that replaces the voter-passed expansion to adults with incomes up to 138% of the federal poverty level with an expansion only to 100% of the poverty level. It passed on a near party-line vote, with one Republican joining all Democrats in opposition.