In the months leading up to Election Day 2012, the pace of health reform implementation slowed considerably as the Obama administration held off on releasing regulations to avoid pre-election controversy. With the 2012 elections now in the books, health reform has scored two major victories: the re-election of President Barack Obama
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Medicare ACOs: Financial and Clinical Integration
By Doug Hastings on
Back in 1996, the Federal Trade Commission and Department of Justice, in providing antitrust guidance for multi-provider networks, considered financial integration and clinical integration as separate pathways for such networks to avoid per se violations of the antitrust laws and, instead, to be treated under the rule of reason, allowing for an assessment of their…
Updated – HHS Publishes Health Insurance Premium Rate Review Final Rule, Amends Rule to Include Policies Sold Through Associations, and Lists States with Effective Rate Review Programs
By Epstein Becker Green on
Posted in Cost of Health Care
EBG Introduces Interactive National Rate Review Scorecard
by Jesse M. Caplan and Lynn Shapiro Snyder
Shortly after the September 1st effective date for the Centers for Medicare & Medicaid Services (CMS) Rate Review Regulations, the U.S. Department of Health and Human Services published an Amendment to the Final Rule that revises the definitions of “Individual…
HHS Publishes Health Insurance Premium Rate Review Final Rule Effective September 1st and List of States with Effective Rate Review Programs
By Epstein Becker Green on
Posted in Cost of Health Care
EBG Introduces Interactive National Rate Review Scorecard
by Jesse M. Caplan and Lynn Shapiro Snyder
On May 23, 2011, the Center for Consumer Information & Insurance Oversight (CCIIO), in the Centers for Medicare & Medicaid Services (CMS) of the United States Department of Health and Human Services (HHS) published its Final Rule implementing Section 2794…
OPM RFI Regarding Multi-State/National Insurance Plans
By Epstein Becker Green on
Posted in Cost of Health Care
by Lynn Shapiro Snyder, Shawn M. Gilman, Adam C. Solander, and Constance A. Wilkinson
On June 16, 2011, the Office of Personnel Management (“OPM”) released the Request for Information (“RFI”) regarding Section 1334 of the Affordable Care Act, which requires OPM to contract with health insurers to offer multi-state qualified health plans (“MSQHPs”).
Meeting the Requirements for Defining the “Essential Health Benefits Package”: DOL Publishes Survey of Employer-Sponsored Coverage
By Epstein Becker Green on
Posted in Cost of Health Care
by Lynn Shapiro Snyder, Clayton J. Nix, and Lesley R. Yeung
The U.S. Department of Labor (“DOL”) released a survey report on April 15, 2011, that is being used to satisfy a requirement in the Patient Protection and Affordable Care Act (“ACA”) that the Secretary of Labor “conduct a survey of employer-sponsored coverage&rdquo…
Is Telemedicine Missing from Health Reform?
By Shawn Gilman on
Posted in Health Information Technology
Perhaps in recognition of its benefits to areas affected by shortfalls in specialists and primary care physicians or the need for remote monitoring, telemedicine received significant funding in the ARRA. For instance, the Rural Utilities Service was allocated $2.5 billion to fund “shovel-ready” distance learning, telemedicine, and broadband program; the Indian Health Services received …
Commonwealth Fund and Population Prepayments
By Mark E. Lutes on
Posted in Articles
Much of the work of the Commonwealth Fund and others seems to presume that payors are a necessary intermediary and should be the entities doling out population prepayment (aka capitation before it was a nasty word). However, it need not work out that way – particularly with House Dems’ concern that Medicare Advantage was profiteering…