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Recently, the U.S. Department of Health and Human Services (“HHS”) rejected North Dakota’s request for a waiver of the Patient Protection and Affordable Care Act (PPACA) requirement that individual health insurance plan issuers spend at least 80% of premiums on medical care or quality improvements.  As we previously reported, under the PPACA, the medical loss ratio (MLR) requirement is 80% for individual and small group plans and 85% for large group plans. …
Read More North Dakota’s Request for Medical Loss Ratio Waiver Rejected; Kentucky’s and Iowa’s Waiver Requests Approved

DEBT CEILING CRISIS AVERTED – IMPACT ON MEDICARE PROVIDERS

On the evening of July 31, President Obama announced that he and congressional leaders from both parties had reached a deal on a debt reduction/debt ceiling increase package, paving the way for legislative action to be completed before the August 2 default deadline. …
Read More Healthcare Update: Debt Ceiling Legislation’s Impact on Medicare; CMS Releases Final Inpatient Hospital Rule – August 8, 2011

CMS RELEASES OUTPATIENT HOSPITAL PAYMENT PROPOSED RULE
The Centers for Medicare and Medicaid Services (CMS) recently released its hospital outpatient prospective payment system (OPPS) proposed rule for 2012, which will impact Medicare reimbursements to more than 4,000 hospital outpatient facilities. …
Read More Healthcare Update: CMS Releases Proposed Rules for Outpatient Hospital Payments and Physician Payments; CMS Proposes Home Health Cuts; Debt Ceiling Agreement Could Include Healthcare Cuts – July 11, 2011

HOUSE AND SENATE DEMOCRATS INTRODUCE MEDICARE BILL

As lawmakers continue negotiations on a federal spending reduction plan that will accompany a vote to raise the debt ceiling this summer, Democrats last week introduced legislation to rein in costs in the Medicare prescription drug program (Medicare Part D). …
Read More Healthcare Update: Democratic Lawmakers Introduce Medicare Bill; CMS Releases Mental Health Center Proposed Rule; HHS Unveils National Prevention Strategy – June 20, 2011

As we originally reported here, the Connecticut Legislature’s proposed bill, S.B. 11, An Act Concerning the Rate Approval Process for Certain Health Insurance Policies, if enacted, would expand the current rate approval process as administered by the Connecticut Department of Insurance for proposed increases of 10% or more for health and long-term care insurance.  The bill has recently passed both the House and the Senate in the legislative body’s third attempt to get such a bill to the governor’s desk. …
Read More Connecticut Health Insurance Rate Increase Symposia Law Passes Through Legislature to Governor’s Desk

CMS UNVEILS THREE NEW ACO INITIATIVES

The Center for Medicare and Medicaid Innovation (CMMI) – part of the Centers for Medicare and Medicaid Services (CMS) – recently announced three new initiatives related to the Medicare Shared Savings Program and Accountable Care Organizations (ACOs). …
Read More Healthcare Update: ACO Update; Senators Express Face-To-Face Concerns

The Centers for Medicare and Medicaid Services (CMS) recently released its Fiscal Year (FY) 2012 proposed rule for hospice reimbursements that would provide for a 2.3 percent payment increase. The agency also included a new quality reporting program in its proposed rule – requiring hospices to submit data on two quality measures beginning in 2014 with payment reductions as a penalty for non-compliance. …
Read More Healthcare Update: CMS Releases FY 2012 Proposed Rule for Hospice Payments, Including Face-To-Face Language; CMS Releases Final Value-Based Purchasing Rule; Legislation Introduced Regarding Treatment of Hospice Patients; ACO News

Following on the heels of double digit health insurance rate approvals last year, the Connecticut Legislature is considering S.B. 11, An Act Concerning the Rate Approval Process for Certain Health Insurance Policies, which would expand the current rate approval process administered by the Connecticut Department of Insurance (the “Department”). …
Read More Proposed Connecticut Law Requires Public Hearings for Health and Long-Term Care Rate Increases of 10% or More

CMS RELEASES FY 2012 PROPOSED RULE FOR HOSPITAL PAYMENTS:

The Centers for Medicare and Medicaid Services (CMS) recently released its annual inpatient prospective payment system (IPPS) proposed rule that determines Medicare reimbursements for the upcoming fiscal year. Under the proposed rule, Medicare payments to acute care hospitals for inpatient services in fiscal year (FY) 2012 would decrease by a projected $498 million, or 0.5 percent. …
Read More Healthcare Update: CMS Releases FY 2012 Proposed Rules for Hospitals and Rehab Facilities; Supreme Court Decides Not To Fast-Track Healthcare Lawsuit