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CMS Imposes New Requirements on Payers to Improve Prior Authorization Process and Payer, Patient and Provider Communications

Hall Render

The improved information requirements apply to the following payers, including: Medicare Advantage plans; Medicaid and Children’s Health Insurance Program (“CHIP”) managed care plans; State Medicaid and CHIP fee-for-service payers; and Qualified Health Plans only in the Federally Facilitated Exchanges.

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CMS Finalizes its Proposal to Advance Interoperability and Improve Prior Authorization Processes

Healthcare Law Blog

The payers impacted by the Final Rule include Medicare Advantage (“MA”) organizations, state Medicaid and Children’s Health Insurance Program (“CHIP”) agencies, Medicaid and CHIP managed care plans, and plans on the Affordable Care Act exchanges (collectively, “Impacted Payers”).

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Long Awaited Approval of the 1115 Waiver Amendment for NYS Medicaid – Just in Time for the New York State Executive Budget State Fiscal Year (SFY) 2025

Health Care Law Brief

The Waiver Amendment was approved on January 9, 2024, by the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115(a) of the Social Security Act and will expire on March 31, 2027. Level I HRSN services are paid for outside of the Waiver Amendment via fee for service or managed care.

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The American Hospital Association Looks at Retail and Tech Health Care Disruptors

Health Populi

hospital sector is facing major challenges on all fronts: staffing (especially nursing and more broadly, clinician burnout), supply chain, financial stressors, demographics, and cross-industry politics vis-à-vis pharma and health insurance. markets by 2025 and planning for 1,000 by 2027.

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A Public Health Wake-Up Call: Reading Between the Lines in IQVIA’s 2023 Use of Medicines Report

Health Populi

It’s a volume speaking volumes on the current picture of prescribed meds, spending and revenues, health care utilization trends, and a forecast looking out to 2027. health care: “Wake up, public health!” is always a detailed, deep, and insightful dive into the state of prescription drugs.

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Consumers and Cancer: 3 Patient-Focused Charts From IQVIA on the State of the Oncology in 2023

Jane Sarashon

Just in time for #ASCO2023, the IQVIA Institute published their annual report on Global Oncology Trends 2023 – Outlook to 2027 , an update featuring pipelines, therapy approvals, research updates, costs of oncology products, and patients. in 2023, and millions of more people worldwide.

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Primary Care in the U.S. – Still a Weak Backbone for the Health of Health Citizens

Jane Sarashon

H+ESG makes so much sense for the private sector and investment community because at least one-half of health care spending is borne by the private sector through employer-sponsored health insurance. Telehealth and virtual care, with embedded mental health on-ramps, will help to scale primary care access.

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