Among the latest proposed rule changes announced by CMS on Monday, officials also said the agency is considering a policy that would require pharmacy rebates to be passed on to seniors.
Category: FierceHealthPayer
Medicaid demonstrations aren’t properly evaluated. Randomized trials could fix that
Section 1115 waivers are meant to be experiments that allow states to test coverage approaches that don’t meet federal program rules. However, most of their evaluations are not rigorously studied, argues a new commentary in the New England Journal of M…
Unsealed whistleblower lawsuit accuses Molina of fraud in Illinois SNF program
A newly unsealed whistleblower lawsuit accuses Molina Health of deceiving state and federal regulators by neglecting to provide mandatory nursing home care, which violated managed care contracts with the state of Illinois.
Payer Roundup—High deductibles force diabetics to delay care; Florida adds CVS, Walgreens to opioid suit
People with diabetes are more likely to delay care if they have a high-deductible health plan, a new study says. Meanwhile, Florida’s AG added CVS and Walgreens to a long list of defendants in its suit over the opioid crisis.
Health tech collaborative hopes to bring valuable solutions to the vulnerable
Medicaid beneficiaries stand to benefit most from the latest health technology, but tech startups often pass them by in favor of seemingly more-lucrative payer partnerships. HealthTech4Medicaid wants to change that.
Top Democrat plans DOJ probe over refusal to defend the ACA in court
With a Texas judge set to make a ruling on the most-recent ACA case any day now, Democratic members of Congress are once again probing the Department of Justice’s refusal to defend the law in court. Only now, they have to deal with Acting Attorney Gene…
Report: Visits to primary care doctors decline, but more patients with employer plans are seeing NPs, PAs
Fewer patients with employer-sponsored insurance are visiting their primary care doctors, but more are seeing other advanced practice providers, according to a new study.
Report: Employers need to ask these questions before they cover genomic tests
There’s a lot of hype around the still-emerging science of genomics. A new guide released by the Northeast Business Group on Health this week offered some guidelines for employers about how to figure out what’s worth covering—and what might not be wort…
Theft and disclosures account for most healthcare data breaches. But hackers took 3 times as many records
Healthcare data breaches due to theft or unauthorized disclosure have been far more common than hacking incidents, according to a new study. But cyber attackers made off with nearly 133 million patient records.
Provider consolidation is causing premium hikes in rural areas, analysis says
A lack of competition among providers, fueled by consolidation, is largely causing the rural-urban disparity. But consolidation shows no signs of slowing down, leaving some wondering if states should take matters into their own hands.
