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Fifth Circuit Upholds ACA Risk Adjustment Program

Healthcare Law Blog

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. And for the 2018 benefit year, HHS promulgated a new rule in December 2018. 3d 1164, 1211 (D.N.M.

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Health Care Paradox: Medicare Penalizes Dozens of Hospitals It Also Gives Five Stars

Kaiser Health News

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. The total amount of the penalties is determined by how much each hospital bills Medicare.

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HHS Issues Proposed Rule to Provide Clarity on Rights of Conscience in Healthcare

Healthcare Law Blog

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

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Texas OIG Inspectors Discover Errors in Reported Nursing Home Staff Hours

Med-Net Compliance

The inspection objective was to determine whether the direct care licensed nursing hours recorded at the nursing home supported the hours submitted to the US Centers for Medicare & Medicaid Services (CMS) in compliance with federal requirements.

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US Rep. Gaetz’s Diagnosis of What’s Driving Insulin Costs Misses the Root Cause

Kaiser Health News

A 2020 study found that the list price of insulin products increased by 262% from 2007 to 2018, while a 2021 study found that from 2014 to 2018 the list price of insulin products increased by 40%. In 2018, the annual number of new diagnoses had risen to about 27 million. Is there a reason the price has ballooned? That is true.

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Tweets at Lunch with Paul Krugman – Health IT Meets Economics

Health Populi

I greatly appreciated the opportunity today to attend a luncheon at the HX360 meeting which convened as part of the 2018 HIMSS Conference. There’s an old saw that the US government is an insurance company with an army” quips @PaulKrugman @HIMSS #HIMSS18 #HX360 #Healthinsurance #Medicare #Healthcare #Healthcosts.

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A Tale of Two America’s for Health

Health Populi

These differences in health status generally fall into two regions: north and south, found in the Commonwealth Fund’s 2018 Scorecard on State Health System Performance. The top row illustrates that the ACA covered a lot of people with health insurances between 2012 and 2016.