Sponsored Content provided by Dane Scalise - General Counsel , GriffinEstep Benefit Group
COVID-19 has tremendously impacted our individual and collective lives for over a year now. It is certainly no surprise to anyone that those impacts have also been felt in the world of health insurance. Unfortunately, the pandemic has resulted in many Americans now being uninsured or underinsured and in need of affordable health insurance. What are their current options?
First, a bit of background about how Americans obtain health insurance for themselves and their families. About half of all Americans receive their health insurance through employer-sponsored health insurance (also called group health insurance). Group health insurance is typically purchased from private insurance companies like Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealthcare and the open enrollment period for employees to sign up for health insurance varies from company to company. Many other Americans receive th
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Because of the COVID-19 pandemic, CMS said April 1 that it won’t update the 855 enrollment form with sections on “affiliation disclosures,” as planned in a 2019 program integrity regulation,
[1]
MLN Matters (SE21003).
[2] It also will adopt a phased-in approach to affiliation disclosures. The regulation, which implements provisions of the Affordable Care Act, is designed to keep, or kick, providers out of Medicare if they pose an “undue risk” of fraud, waste or abuse. It requires providers to disclose “affiliations” with other providers who have been suspended or excluded from Medicare, Medicaid or the Children’s Health Insurance Program (CHIP); owe the programs money; or had their billing privileges denied or revoked.
MACPAC approves recommendations on specialty drugs, behavioral health
MACPAC approves recommendations on specialty drugs, behavioral health
Modern Healthcare Illustration / Getty Images
Commissioners voted to recommend that Congress increase the minimum rebate percentage and additional inflationary rebate on drugs approved by the Food and Drug Administration through the accelerated approval program. MACPAC commissioner Thomas Barker was the only commissioner to vote against the measure.
According to MACPAC, the changes would lower Medicaid spending on high-cost specialty drugs. Drugmakers and some patient advocates claim those moves could discourage pharmaceutical companies from bringing new products to market. But many experts disagree, arguing that historical evidence shows those claims are mostly unsupported and that drugmakers financial incentives would remain largely the same.
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In a March 24, 2021 CMS MLN Matters Special Edition Article, SE21003, CMS announced that [i]n light of the pandemic and various other factors, we will not begin updating the Form CMS-855 applications with affiliation disclosure sections for at least another 12 months. The Program Integrity Enhancements to the Provider Enrollment Process Rule (Medicare Provider Affiliation Rule) was finalized on September 10, 2019, requiring,
inter alia, providers and suppliers initially enrolling or revalidating to disclose all affiliations that it or any of its owning or managing employees or organizations have had within the previous five years with a currently or formerly enrolled Medicare, Medicaid, or CHIP provider or supplier that has a disclosable event. The terms affiliation and disclosable event are defined in 42 C.F.R. § 424.502.
Capitol Update: Rep. Lindsey Vaughn says Kansas legislature is out of excuses on Medicaid expansion
Last week the Kansas House saw its first opportunity to vote on Medicaid Expansion this session.
No Medicaid bills have been worked this year at the request of Republican House leadership, so this opportunity was a result of the Democrats bringing an amendment to the comprehensive budget bill on the House floor.
The carrier of the original bill challenged the Medicaid Expansion amendment under the rules of “pay-go,” meaning that if a legislator wants to “pay” for an additional line item in the budget something else relevant must “go.”