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The merger also needs the green light from 23 other states and ultimately the Department of Justice, which is also weighing the proposed $38.5 billion consolidation of Aetna and Humana. MORE
Template includes coverage examples that demonstrate cost sharing amounts. MORE
The Internal Revenue Service doesn't tell tax filers that their low and moderate incomes likely mean their households qualify for Medicaid or subsidies to buy coverage on the insurance exchanges.  MORE
Exchange websites that do not call attention to the quality of medical care in a plan are more likely to see consumers selecting the low-cost alternative, according to Health Affairs. MORE
The federal and state marketplaces would do well to nudge consumers toward health plans that result in the best fit for the individual, according to a Health Affairs report. MORE
The total 3.05 percent rate is less than the total 3.55 percent CMS proposed in February. MORE
While healthcare provider directories have always been hard to maintain, new regulations can mean costly fines if insurers fail to keep accurate, up-to-date information on the physicians who are in their health plans. MORE
UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive. MORE
Once the transition to full Medi-Cal occurs, beneficiaries will have 60 days to choose a managed care health plan for children already enrolled in restricted-scope Medi-Cal. MORE
The healthcare system in the United States is spending billions per year unnecessarily by continuing to use manual administrative processes, according to the 2015 CAQH Index that measures the shift to electronic HIPAA transactions between health plans and healthcare providers. MORE
The rate of security incident disclosures in 2015 surpassed those of 2014, according to the second annual BakerHostetler Security Incident Response report. What's more, healthcare tops the list for frequency of data breaches. MORE
The Centers for Medicare and Medicaid Services is aligning mental health and addiction payment requirements already in place for private health plans to states providing these services to low-income adults and children. MORE
The interagency task force, which will be chaired by the White House's Domestic Policy Council, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. MORE
EmblemHealth and Northwell Health in New York have agreed to share risk in value-based contracts, EmblemHealth announced March 25. MORE
The payer mix in a hospital system exerts enormous influence over its financial success and stability, or lack thereof, said the commission. For community hospitals, a large share of their patients are covered by government payers, and that means lower rates than for commercial patients. MORE
After insurers dropped hundreds of providers in 2013, the Centers for Medicare and Medicaid Services issued rules giving people a "special enrollment period" to change plans or join regular Medicare if there was a "significant" change in their provider network. MORE
For the program to work, it requires cooperation between providers and health plans, according to AHIP President and CEO Marilyn Tavenner. MORE
Errors in insurance claims are costing the healthcare industry billions in wasteful spending, and both the payers and the providers are at fault, experts say. MORE
The Maine Bureau of Insurance is closely monitoring Community Health Options, as the nation's only profitable co-op under the Affordable Care Act in 2014 posted a net loss of $74 million for 2015 and 2016 this month, according to information on the maine.gov website. MORE
The Aetna Whole Health-Virtua plan will be introduced in South Jersey later this year and will use Virtua's community-based health system of hospitals, outpatient facilities, urgent care centers, and health and wellness centers. MORE
Hemorrhaging money, many insurers left the long-term care business. Those that remain are in financial trouble on their policies. They're charging far more for new policies, and sharply raising the premiums of old ones. MORE
Insurers are investing in programs that have moved beyond tobacco-free living sessions and gym membership benefits. MORE
Insurers, which have long resisted efforts to let competitors or the public see the deals they make with doctors and hospitals, have aligned with providers against a plan by California's insurance exchange to cut hospitals from its networks for poor performance or high costs. MORE
The Supreme Court has sided with Liberty Mutual Insurance and against the state of Vermont in a decision that could have implications for insurers nationwide. MORE
The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. That percentage is approaching two-thirds of all covered drugs. MORE
The House Ways and Means Health Subcommittee held a bipartisan debate Wednesday over the future of Medicare and planned cuts to the Medicare Advantage program as sharp party divides over healthcare continue to widen. MORE
Here are three specific changes finalized by the Department of Health and Human Services that affect consumers who buy their own health insurance in one of the 38 states using the online federal insurance exchange. MORE
While the Centers for Medicare and Medicaid Services is touting the success - 11 months ahead of schedule - of tying 30 percent of fee-for-service Medicare payments to alternative payment models such as accountable care organizations and bundled payments, questions still remain over how much money value-based programs will save. MORE
The American Medical Association, the Florida Medical Association and the Florida Osteopathic Medical Association are calling on Florida Attorney General Pam Bondi to reject the proposed merger of health insurer giants Aetna and Humana, according to a March 14 release from the AMA. MORE
Donald Trump's plan to repeal and replace Obamacare would cost an estimated $270 billion over ten years and would nearly double the number of uninsured Americans, according to the Committee for a Responsible Federal Budget, a nonprofit, bipartisan fiscal watchdog group. MORE
In 2016, health insurance co-ops have gained needed enrollment but half of those set up under the Affordable Care Act three years ago have failed, costing taxpayers over $1 billion, according to a Senate subcommittee which has investigated what went wrong. MORE
While accountable care organizations piloted by the Centers for Medicare and Medicaid services are expanding due to the government's focus on alternative payment models, ACOs run by private insurers are growing as health systems weigh the benefits of joining. MORE
Rising prices and big-dollar medications are leading to increases in prescription drug spending, the Department of Health and Human Services has found. MORE
The Centers for Medicare and Medicaid Services is scrapping its policy of automatically reducing the star ratings for contracts under sanction, a decision that affects the bonus payments and rebates for plans in a state of penalty. MORE
Physician and pharmaceutical groups have come out swinging against the Centers for Medicare and Medicaid Services' proposal to reduce the reimbursement price for Medicare Part B prescription drugs. MORE
Despite efforts to shift provider payment away from fee-for-service and toward more risk-based alternatives, fee-for-service remains dominant -- and is growing, according to a study published in Health Affairs. MORE
The Centers for Medicare and Medicaid Services has levied a $3.1 million penalty against Humana, the single largest imposed against 129 organizations found in violation of Medicare Advantage and prescription drug plans in a 2015 audit. MORE
In a 'major milestone' for the Affordable Care Act, 30 percent of Medicare payments are now made through alternative payment models. MORE
A recent analysis by the Health Care Cost Institute has found that less than 7 percent of total healthcare spending in 2011 was paid by consumers for what it called "shoppable" services. MORE
LAS VEGAS -- Mitt Romney ran down the list of Presidential candidates and suggested ways each might change healthcare as president. MORE
LAS VEGAS – Officials from the Centers for Medicare and Medicaid Services on Wednesday said physicians should expect meaningful use of electronic health records to still be required under coming changes to how CMS pays them under MACRA. MORE
LAS VEGAS -- When Inova Health saw that Affordable Care Act initiatives for value-based care would cut 7 percent, or $220 million, out of the $3 billion health system's successful fee-for-service revenues, the northern Virginia provider knew it needed to change, said President and COO Mark Stauder. MORE
MIT Sloan Professor Andrew Lo, Dana-Farber Cancer Institute's David Weinstock, and MIT post-doctoral fellow Vahid Montazerhodjat have identified this as a time when breakthrough therapies for certain types of cancers, hepatitis C, and rare diseases exist but remain out of reach for many patients, due primarily to the prohibitive cost. MORE
The Centers for Medicare and Medicaid Services on Monday issued its final annual notice of benefit and payment parameters for the 2017 health insurance marketplace. MORE
The head of Aetna Inc., the nation's third-largest health insurer, said he supports insurance exchanges, even though he questioned their sustainability earlier this month and lost money in the marketplaces last year. MORE
Health information exchange is an essential tool to support the transition to value-based payment models, according to Alex Baker of the U.S. Department of Health and Human Services, who gave an overview of federal initiatives and how states, hospitals and physicians can benefit from the innovations, during HIMSS16 in Las Vegas. MORE
South Dakota Gov. Dennis Daugaard has announced the state will not seek Medicaid expansion this legislative session, saying with only a few days left during the current stretch there isn't enough time to thoroughly consider the issue. MORE
The Centers for Medicare and Medicaid Services is now requiring consumers who sign up for health insurance coverage during special enrollment periods to submit proof of eligibility, a move that the health insurance industry is applauding. MORE
The Centers for Medicare and Medicaid Services has proposed, in its new Medicare Advantage rate notice, to waive the bidding requirement for employers and union groups that offer retirement plans to their employees. MORE
Republican Iowa Governor Terry Branstad has announced expanded Medicaid coverage for eligible residents in his state through a program he is calling Medicaid modernization. MORE

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