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Jun 20, 2018

The CMS has submitted a series of legislative ideas to Congress they say would better coordinate care for people eligible for both Medicare and Medicaid. These beneficiaries tend to be sicker and more expensive to manage.

The first idea is to make permanent a demonstration on retroactive Medicare Part D coverage for low-income beneficiaries.

Currently, low-income beneficiaries are assigned at random to a qualifying Part D plan, which is reimbursed based on the standard Part D...

Jun 20, 2018
The CMS has issued a request for information to determine how it can minimize the regulatory barriers of federal anti-kickback laws and support providers' move to value-based care.

Hospitals have said the Stark law makes it difficult for physicians to enter innovative payment arrangements because they are not susceptible to fair-market value assessment, a Stark requirement. Now, they'll get the chance to answer 20 questions for the CMS on how the law's enforcement should change.

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Jun 20, 2018

The top executives of some of the most successful businesses in America have handed the reins of their healthcare joint venture to one of the most respected thought leaders in the industry—Dr. Atul Gawande.

With a trifecta of medical expertise, policy prowess and communication skills, Gawande is seen by many experts as an ideal pick to lead the Amazon, JPMorgan Chase, Berkshire...

Jun 20, 2018

Regulators and insurance experts worry the Trump administration's new rule expanding association health plans for small businesses and self-employed people will lead to a spike in insurance fraud and insolvencies that plagued consumers and healthcare providers in the past.

The Labor Department's 198-page final rule, issued Tuesday in response to President Donald Trump's executive order in October, will make it easier for small firms and individuals to band together across state lines...

Jun 20, 2018
Dr. Atul Gawande will lead the Boston-based Amazon, Berkshire Hathaway and JPMorgan Chase healthcare venture, the companies announced Wednesday.

Gawande practices general and endocrine surgery at Brigham and Women's Hospital and teaches at the Harvard T.H. Chan School of Public Health and Harvard Medical School. He is also the executive director of Ariadne Labs, a staff writer for The New Yorker and a best-selling author who is widely recognized for his contributions to the healthcare...

Jun 20, 2018

CVS Health and Aetna executives defended their $69 billion proposed merger before the California insurance commissioner on Tuesday, as a panel of antitrust experts and healthcare providers chipped away at the companies' promise to lower U.S. healthcare costs and improve the quality of care without harming competition.

Although California Insurance Commissioner Dave Jones doesn't have direct approval authority over the merger because Aetna isn't based in California, his opinion could...

Jun 20, 2018

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This story can be republished for free (details).

Marilyn Bartlett, the director administrator of Montana’s Health Care and Benefits Division, recalls thinking “holy cow” when she got an urgent directive from state legislators in late 2014: “You have to get these costs under control, or else.”

Increasing health care costs in the state workers’ health plan were helping hold down workers’ wages. The plan’s financial reserves were...

Jun 19, 2018

The Medicaid and CHIP Payment and Access Commission called on Congress to make key changes to the Medicaid drug rebate program to cut spending on drugs for low-income people.

Under the program, Medicaid covers drugs if the pharmaceutical companies are willing to have a national rebate agreement with HHS. Manufacturers must pay a rebate on drugs purchased by Medicaid programs.

MACPAC claimed Friday in its annual report that Congress could improve the program with two tweaks...

Jun 19, 2018

Roughly only one-third of patients who experienced non-fatal opioid overdose were prescribed some form of medication-assisted treatment, according a new study.

Experts say that's causing thousands of people to miss out on a treatment that's proven to reduce the rate of death from overdose.

The findings were published...

Jun 19, 2018
Integris Health in Oklahoma has chosen Timothy Pehrson as its next CEO. Pehrson most recently served as Intermountain Healthcare's regional vice president and vice president of continuous improvement. He officially starts Aug. 1.

Pehrson was chosen after a national search following the retirement of Bruce Lawrence, who served as CEO of the Oklahoma City-based system since 2010.

Executive Vice President and Chief Operating Officer Chris Hammes led the system on an interim basis since...

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