CMS recently published the First Annual Evaluation Report (the “Report”) highlighting its most significant observations in the first year following implementation of the Kidney Care Choices Model (the “KCC Model”). By way of...more
California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the California Medical...more
5/9/2024
/ Affordable Care Act ,
Algorithms ,
Analytics ,
Artificial Intelligence ,
Bias ,
California ,
Centers for Medicare & Medicaid Services (CMS) ,
Discrimination ,
Health Care Providers ,
Healthcare ,
Insurance Industry ,
Machine Learning ,
Managed Care Contracts ,
Popular ,
Section 1557
On December 20, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on program integrity for Affordable Care Act (ACA) exchange plans. This rule implements a number of provisions from the ACA,...more
The most recent MA Call Letter, “Announcement of Calendar Year (CY) 2018 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter and Request for Information” (Call Letter)...more
This past May, the Department of Health and Human Services (HHS) issued a final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin,...more
8/5/2016
/ Affordable Care Act ,
Children's Health Insurance Program (CHIP) ,
Contraceptive Coverage Mandate ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Federal Funding ,
Final Rules ,
Gender Identity ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
LGBTQ ,
Medicaid ,
Medicare ,
Non-Discrimination Rules ,
Section 1557 ,
Sex Discrimination ,
Sexual Orientation Discrimination ,
Transgender
On June 27, CMS issued a proposal for the 2017 Medicare home health prospective payment system (HH PPS).
CMS is proposing a $180 million reduction in 2017. This equates to a 1% drop in reimbursements for home health...more
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) passed an interim final rule that amends regulations governing Consumer Operated and Oriented Plans (Co-ops) and tightens restrictions on special...more
Three states—Kansas, Louisiana and Texas—filed a complaint in federal court on October 22, 2015 challenging the constitutionality and legality of the Affordable Care Act’s health insurance providers fee.
The health...more
The Center for Medicare and Medicaid Services (CMS) recently announced that it will add roughly 4,100 providers to the 2,400 existing providers testing the possible use of Medicare bundled payment contracts. Providers must...more
Perhaps putting added pressure on insurers as they prepare to set rates for 2015, new evidence suggests that people enrolled in health plans under the Affordable Care Act have higher rates of serious health conditions than...more