CMS Adds Health Plan Ratings to ACA Exchanges
August 20, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
The Centers for Medicare & Medicaid Services (CMS) announced on August 15 that health plans offered on health insurance exchanges will be ranked using a five-star quality rating system for the 2020 plan year open enrollment period that begins on November 1, 2019. The ratings will appear on both state-based exchanges and the federal exchange, …
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Medicare Physician Fee Schedule for 2020 Includes Telehealth Changes
August 15, 2019 | Eric D. Fader | Home Health | Legislation and Public Policy | Medicare and Medicaid | Telehealth
On July 29, the Center for Medicare and Medicaid Services (CMS) released its proposed revisions to the Medicare Physician Fee Schedule for 2020. The Proposed Rule was published in the Federal Register on August 14. CMS proposed to add three new codes for treatment of opioid use disorder to the list of services that are …
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Genetic Testing Scam Targets Medicare Beneficiaries
August 14, 2019 | Eric D. Fader | Fraud and Abuse | Medicare and Medicaid
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Fraud Alert on August 13 regarding a genetic testing scam targeting Medicare beneficiaries. The scammers will offer a “free” screening for genetic testing but then submit a claim to Medicare, which will likely deny the claim as medically unnecessary. The …
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NY IPA Focuses on Social Determinants of Health
August 13, 2019 | Cassandra Rivais DiNova | 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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NY DOH Revises Policy for ASC Approval
August 6, 2019 | Benjamin P. Malerba | Ada Kozicz | Hospitals | Legislation and Public Policy
The New York State Department of Health (DOH) recently revised its policy regarding the review and approval process for Certificate of Need (CON) applications for ambulatory surgery centers (ASCs). The DOH’s current public need criteria favor the approval of new ASCs because they allow patients to obtain safe, low-cost and convenient surgical services outside a …
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Back to School: No Religious Exemption for Immunizations in New York
July 29, 2019 | Cassandra Rivais DiNova | Legislation and Public Policy | Litigation
As parents and healthcare providers prepare for the start of the new school year, there are now more than 26,000 students who will need to get vaccinated as New York has eliminated exemptions from vaccinations due to religious beliefs. New York Public Health Law §§ 2164 and 2165 require students to be immunized against diphtheria, …
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Marijuana Legalization Bills Introduced in Congress
July 26, 2019 | Cassandra Rivais DiNova | Mark J. Wagner Jr. | Cannabis | FDA | Legislation and Public Policy
On July 23, companion legislation was introduced in the House and Senate by Senator Kamala Harris of California and New York Congressman Jerrold Nadler to legalize and tax marijuana at the federal level. The tax revenue from this legislation would support job training, substance abuse treatment, literacy programs, and other services for communities that have been …
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OIG Audit Reveals NY Medicaid Eligibility Errors
July 25, 2019 | Margarita Christoforou | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid
Based on a recent audit of payments under New York’s Medicaid program, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) estimated in a report that the state made hundreds of millions of dollars in payments to ineligible or “potentially ineligible” beneficiaries. The audit examined payments to “non-newly eligible” beneficiaries, meaning …
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LabCorp Offers Self-Directed Blood Testing (but not in NY/NJ)
July 24, 2019 | Eric D. Fader | Home Health | Medical Devices and Wearables
LabCorp announced on July 22 that it is now offering blood tests directly to consumers online. The clinical lab giant’s “Pixel by LabCorp” platform previously offered self-directed test kits for colorectal cancer and diabetes screening, as well as lipid panels. The service is not currently offered in New York, New Jersey, Maryland or Rhode Island. …
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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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