Private Insurers

NY IPA Focuses on Social Determinants of Health
August 13, 2019 | Behavioral Health | Home Health | Legislation and Public Policy | Medicare and Medicaid | Private Insurers

On August 6, health insurer MVP Health Care announced an affiliation with Alliance for Better Health to address so-called social determinants of health in the Albany, New York area. The newly formed independent practice association (IPA), Healthy Alliance Independent Practice Association, is one of the first IPAs in the U.S. to focus exclusively on social

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CVS Announces Home Dialysis Machine Trials
July 22, 2019 | Eric D. Fader | FDA | Home Health | Medical Devices and Wearables | Pharmaceuticals | Private Insurers

On July 17, CVS Health Corp. announced the beginning of human trials of a new home dialysis machine called the HemoCare Hemodialysis System. The company’s CVS Kidney Care unit hopes to shift some of the $35 billion market for end-stage kidney care from outpatient dialysis clinics to patients’ homes.

The HemoCare device was designed by

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OCR Releases New HIPAA FAQs on Care Coordination
July 16, 2019 | Ada Janocinska | HIPAA | Legislation and Public Policy | Private Insurers

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) recently issued new guidance on its HIPAA FAQs webpage regarding permissible use and disclosures of protected health information (PHI) by health plans for purposes of care coordination and continuity of care. Health plans are covered entities under HIPAA.

The guidance explains that,

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States Pick Up ACA Slack
July 12, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Private Insurers

With the political battle over the future of the Affordable Care Act (ACA) dragging on in Washington, a number of states have recently taken steps to protect their residents from potential instability in the health insurance market. New Jersey is setting up its own state health insurance exchange to replace the federally run marketplace,

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NYS Reaffirms Support for No-Fault Fraud Law
May 6, 2019 | Rivkin Rounds Staff | Fraud and Abuse | Legislation and Public Policy | Litigation | Private Insurers

The New York State Department of Financial Services has filed an amicus brief with the New York Court of Appeals reaffirming its position that a medical professional corporation “is not eligible for reimbursement” under the state’s No-Fault Law “if the provider fails to meet any applicable New York State or local licensing requirement necessary to

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Centene’s Proposed WellCare Acquisition May See DOJ Scrutiny
May 2, 2019 | Eric D. Fader | Antitrust | Fraud and Abuse | Medicare and Medicaid | Private Insurers

An April 30 article in Managed Care, “Centene, big in Medicaid managed care, wants to get even bigger,” discussed the business plans of Centene, the largest Medicaid managed care insurer in the U.S.  Rivkin Radler’s Christopher J. Kutner was quoted in the article.

Centene is hoping that its proposed acquisition of WellCare Health Plans will

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HHS Announces New Primary Care Pay Models
April 23, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers

On April 22, U.S. Department of Health and Human Services (HHS) officials announced the introduction of five optional value-based care models for large and small primary care physician practices. The new payment models will incorporate incentives for keeping Medicare patients healthy, as alternatives to traditional fee-for-service payment structures.

Alex Azar, HHS Secretary, and Seema Verma,

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Amazon’s Alexa Now HIPAA-Compliant
April 18, 2019 | Eric D. Fader | Cybersecurity | Electronic Health Records | HIPAA | Home Health | Hospitals | Medical Devices and Wearables | Private Insurers | Telehealth

Amazon announced in a blog post on April 4 that its Alexa voice assistant’s operating environment now complies with HIPAA. Companies that build functions, or skills, for Alexa will now be able to create skills that involve the transmission of users’ protected health information.

The initial group of six participants in an invitation-only program includes

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New Plan Designs for Medicare Parts C and D are Coming
April 9, 2019 | Christopher J. Kutner | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals | Private Insurers

On April 5, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-4185-F) that updates the Medicare Advantage (MA or Part C) and Medicare Prescription Drug Benefit (Part D) programs by promoting innovative plan designs, improved quality, and choices for patients.

The final rule will increase MA plan choices for the 2019

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New York State Budget Includes ACA-Type Protections
April 3, 2019 | Eric D. Fader | Affordable Care Act | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes | Private Insurers

New York’s state budget for the 2019-2020 fiscal year, approved by the State Legislature on March 31, included provisions that codify into state law the primary consumer protections of the federal Affordable Care Act. In a public announcement, Gov. Andrew Cuomo said, “We have codified many of the protections of Obamacare, so regardless of what

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