Center for Health Insurance Reform

MARCH 31, 2023

The Affordable Care Act (ACA) recently celebrated its 13th anniversary with historic enrollment growth in the health insurance Marketplaces and the lowest-ever recorded uninsured rate.

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Health Insurance ACA Medicaid Medicaid 75

Kaiser Health News

OCTOBER 13, 2022

Meanwhile, open enrollment for Medicare begins Oct. 15, when beneficiaries can join or change private Medicare Advantage plans or stand-alone prescription drug plans. Democrats were aware of this problem even as they passed the ACA. The Obama administration had decided that only Congress could fix the glitch.

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Medicare Medicare ACA Overpayments 96

Hall Render

FEBRUARY 21, 2023

For SNFs, the data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). For NFs, the data would be reported via means prescribed by the particular state Medicaid agency. Hall Render blog posts and articles are intended for informational purposes only.

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Kaiser Health News

JULY 6, 2022

Since late 2010, when this provision of the ACA took effect, many patients have paid nothing when they undergo routine mammograms, get one of more than a dozen vaccines, receive birth control, or are screened for other conditions, including diabetes, colon cancer, depression, and sexually transmitted diseases. The ACA does set parameters.

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Healthcare Law Blog

MARCH 25, 2022

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. United States Dep’t of Health & Hum. 20-50963, 2022 WL 807554, at *1 (5th Cir. The Risk-Adjustment Program.

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ACA US Department of Health and Human Services Health Insurance Medicaid 52

Compliance Now

JANUARY 13, 2022

To comply with the ACA, non-grandfathered health plans cannot require a participant to pay more out-of-pocket during the plan year than the amounts listed below. Under the ACA, the out-of-pocket limitation requirement directly applies to essential health benefits. This is a $.13

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Bill of Health

JANUARY 26, 2022

This policy would be particularly significant in states that have expanded Medicaid under the Affordable Care Act (ACA) , because justice-involved populations largely intersect with those made eligible for Medicaid in expansion states (namely, people who earn less than 138% of the federal poverty level).

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Healthcare IT Today

JULY 1, 2020

From Medicare Risk Adjustment (MRA) requests to HEDIS requests, Affordable Care Act (ACA) records retrieval, RADV, DRG Audit, CIP and QIP: the alphabet soup of chart request types […]. The following is a guest article by Steve Mallinak, Senior Vice President of Operations at Ciox.

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Health Populi

JUNE 18, 2021

workers with private insurance more likely report poor access to health care, greater costs of care, and lower satisfaction with care versus people covered by public health insurance plans — whether Medicaid, Medicare, VHA or military coverage. Health Populi’s Hot Points: U.S. households.

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Health Insurance ACA Medicaid Medicaid 139

Center for Health Insurance Reform

MARCH 31, 2022

In the proposed Notice of Benefit and Payment Parameters for 2023, the Centers for Medicare & Medicaid Services asked for feedback on how to promote health equity through ACA marketplace operations and plan certification standards.

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Healthcare IT News - Telehealth

AUGUST 29, 2022

Galileo first launched with in-home care for Medicare and Medicaid patients, creating a framework to include social determinants of health in clinical analysis and to bridge gaps in healthcare education. We currently power UnitedHealthcare's Virtual-First ACA Exchange plan in multiple states with more coming in 2023.

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Healthcare Law Blog

JANUARY 26, 2023

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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Medicaid Medicaid ACA Medicare 105

Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). The public has until 5 p.m.

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Overpayments Overpayment Medicare Medicare 52

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. In addition, the ACA amended Section 1833(b)(1) of the Act to waive the Part B deductible for screening colonoscopies, which includes moderate sedation services as an inherent part of the screening colonoscopy procedural service.

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Health Law RX

MAY 3, 2022

Federal appeals courts have been split on whether such damages are available to plaintiffs bringing discrimination claims under the Rehabilitation Act of 1973 (Rehab Act) and the Patient Protection and Affordable Care Act (ACA). The Rehab Act bars funding recipients from discriminating because of disability.

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ACA Medicaid Medicaid Medicare 52

HIT Consultant

NOVEMBER 22, 2021

Health Fidelity’s technology uncovers insights that enable better care planning and more complete revenue capture; giving health plans and providers the ability to succeed in risk-sharing arrangements across Medicare Advantage, Affordable Care Act (ACA), Medicaid, and Accountable Care Organization programs. Post-Acquisition Plans.

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ACA Medicaid Medicaid Medicare 52

Health Populi

APRIL 2, 2021

By age, younger Non-White adults have a harder time paying for health care — not a surprise as older Americans 65 and over can access Medicare. adults, cross-party ID, support setting caps on out-of-pocket costs for prescription drugs and general medical services for folks in the Medicare program. Health care spending for U.S.

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Medicare Medicare COVID-19 ACA 83

Kaiser Health News

JANUARY 12, 2023

But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees. Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug. One thing is certain: The new GOP-controlled House will do a lot of investigations.

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FDA Medicare Medicare ACA 79

Bill of Health

FEBRUARY 10, 2023

Failing to anticipate litigation that challenges our efforts, such as with the ACA or the upcoming attempt to “codify Roe v. They brought at least five significant lawsuits designed to impede the Affordable Care Act, restricting the positive impact of the ACA’s Medicaid reforms and the use of the individual mandate.

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Health Populi

OCTOBER 8, 2019

The Centers for Medicare and Medicaid Services (CMS) forecasts that prescription drug spending will be the fastest-growing cause of rising health spending by 2027. More savings would accrue through the quicker adoption of value-based payment models, the authors assert, where clinicians take on financial risk for managing population health.

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Prescription Drug Pricing Medicare Medicare Health Insurance 108

Health Populi

MARCH 11, 2021

health care, patient assistance programs, Medicare Advantage plans, and the bundling of proven high-value preventive services into the Affordable Care Act. These services are enumerated in Section 2713 in the ACA , prompting Dr. Kavita Patel to assert in the first panel of the day that, “2713 is my favorite number.”

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Health Insurance Medicare Medicare ACA 101

Kaiser Health News

MAY 31, 2022

The former generally incurs no cost to patients under the ACA; the latter can generate bills. Remind your provider that the government’s interpretation of the ACA requires that colonoscopies be regarded as a screening even if a polyp is removed.

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ACA Hospitals Medical Billing Doctors 122

Bill of Health

MAY 12, 2023

HIPAA and the ACA both responded to concerns about “job lock” – that employer-sponsored insurance restricted job mobility and entrepreneurship. Fertility treatment and the infertility shift only add to this stress. The infertility shift further distorts the already fun-house mirror effects of employer-sponsored insurance on the labor economy.

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Medicaid Medicaid ACA Health Insurance 209

Healthcare Law Blog

MAY 17, 2022

On January 5, 2022, we discussed the Notice of Benefit and Payment Parameters for 2023 proposed rule released by the Centers for Medicare & Medicaid Services (CMS). On April 28, 2022, CMS issued the NBPP 2023 Final Rule. CMS published a Fact Sheet and other resources on April 28, 2022.

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ACA Health Insurance Medicaid Medicaid 52

Healthcare IT Today

DECEMBER 22, 2020

CMS has released a proposed rule that will require Medicaid managed care plans and other insurers offering products on the ACA Exchanges to support the sharing of patient data amongst themselves.

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Medicaid Medicaid ACA Medicare 145

Healthcare IT Today

JULY 14, 2022

Is the algorithm in question used for Medicare, Medicaid, or ACA populations? Similar situations could arise around specific medical conditions where clustering around common environments for physically distant regions could provide higher volumes of data. Health coverage program.

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The Health Law Firm

MAY 9, 2014

., Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) is enforcing fingerprint-based background checks for Medicare suppliers and providers designated as "high risk."

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Medicare Medicare ACA Medicaid 40

Healthcare Law Blog

AUGUST 25, 2022

The expansive legislation includes key health care provisions, including drug pricing reforms, inflationary rebates, Medicare Part D benefit redesign, as well as myriad other updates. Medicare Drug Price Negotiation Program. The Inflation Reduction Act (“IRA”) was signed into law by President Biden on August 16, 2022.

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Medicare Medicare Medicaid Medicaid 52

Kaiser Health News

JANUARY 27, 2022

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify , Apple Podcasts , Stitcher , Pocket Casts or wherever you listen to podcasts. The Biden administration announced that 14.5 million Americans have signed up for health insurance under the Affordable Care Act for 2022.

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ACA Public Health COVID-19 Health Insurance 94

Healthcare IT Today

APRIL 10, 2023

Notably, our payer clients have measured drastic savings to medical costs by preventing hospitalizations and ED visits, and we’ve helped Medicare Advantage plans achieve higher Star ratings. Medicare Advantage, Medicaid, ACA/Exchange) that share in our mission.

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Health Outcomes Hospitals Medicare Medicare 111

Kaiser Health News

JANUARY 19, 2022

A spokesperson for the Centers for Medicare & Medicaid Services said in an email that the agency is not seeing a pervasive problem, but he declined to provide data on how often such cases occur or how the agents or brokers get the personal information needed to enroll unsuspecting people.

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Health Insurance ACA Licensing Fraud 105

HIT Consultant

SEPTEMBER 15, 2021

By integrating Talix’s technology with Edifecs’ signature Encounter Management solution, Edifecs will provide the opportunity for customers to operate risk adjustment processes more efficiently for Medicare Advantage, Managed Medicaid, and Affordable Care Act (ACA) products.

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ACA Medicaid Medicaid Medicare 52

Kaiser Health News

JUNE 16, 2022

La deuda de los pacientes se acumula a pesar de la histórica Ley de Cuidado de Salud a Bajo Precio (ACA) de 2010. ACA amplió la cobertura de seguro a decenas de millones de estadounidenses. Muchos hospitales prosperaron incluso durante la pandemia. El papel de Washington.

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HIT Consultant

DECEMBER 20, 2021

This will make hundreds of thousands more Medicaid, Medicare Advantage, and ACA exchange health plan members eligible for the holistic, culturally competent services offered by the Equality Health care model.

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ACA Medicaid Medicaid Medicare 52

Bill of Health

FEBRUARY 27, 2023

Under the ACA, for instance, the health insurance exchanges must be implemented by HHS if states do not create them. United States , which held Congress cannot “dragoon” state executive officials to implement federal laws. Federal statutes enacted after these decisions in the mid-1990s tend to include a federal fallback.

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Public Health Medicaid Medicaid Health Insurance 246

Medisys Compliance

APRIL 25, 2023

In addition, you should ensure that the billing company is knowledgeable about and compliant with other relevant regulations, such as the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA).

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Regulatory Compliance Compliance ACA Health Insurance 52

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). In states that have not expanded Medicaid, however, many postpartum women lose coverage.

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Medicaid Medicaid Public Health ACA 52