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HHS announced a record-breaking 14.5 million people signed up for coverage under the Affordable Care Act during open enrollment thanks to enhanced subsidies that expire after this year. [ABSTRACT FROM AUTHOR]

The number of ACOs in the Medicare Shared Savings Program increased modestly to 483, which advocates say is a major warning sign for the program. [ABSTRACT FROM AUTHOR]

A group of nearly 20 Democratic senators is calling for HHS to enable Medicare to reimburse at-home COVID-19 tests for seniors just like a requirement for commercial insurers. [ABSTRACT FROM AUTHOR]

A new analysis from the Kaiser Family Foundation discovered that seven of 13 major insurers are not offering direct coverage of at-home COVID-19 tests and instead relying on methods such as mail or fax. [ABSTRACT FROM AUTHOR]

State officials are asking for more time and predictability when the COVID-19 public health emergency ends and when Medicaid eligibility redeterminations are expected to start. [ABSTRACT FROM AUTHOR]

CMMI is taking a hard look at its risk adjustment methodology after multiple reports of Medicare Advantage plans upcoding to inflate risk scores, director Liz Fowler said. [ABSTRACT FROM AUTHOR]

President Joe Biden endorsed splitting up his $1.75 trillion Build Back Better Act, but it remains unclear what healthcare policies could survive such a piecemeal approach. [ABSTRACT FROM AUTHOR]

House Democrats are ramping up pressure on CMS to rethink a 14.5% hike to Medicare Part B premiums after Biogen halved the price of Alzheimer's drug Aduhelm. [ABSTRACT FROM AUTHOR]

A new analysis from MedPAC found a majority of beneficiaries in Medicare Parts A and B will be in Medicare Advantage by next year, but spending in MA continues to outpace traditional Medicare. [ABSTRACT FROM AUTHOR]

MedPAC did not recommend that Congress make any additional payments in 2023 to hospitals and doctors beyond current law, noting that targeted relief payments have helped blunt the financial impact of COVID-19. [ABSTRACT FROM AUTHOR]

More than 14 million people signed up for ACA coverage as of Jan. 8 thanks to enhanced subsidies passed under the American Rescue Plan Act. [ABSTRACT FROM AUTHOR]

BCBS Massachusetts is incorporating data and progress metrics into payment models. Over the next three years, the organization expects to incorporate financial incentives around closing racial inequities, one executive said. [ABSTRACT FROM AUTHOR]

Payer groups applauded CMS' proposal to onlycover the controversial Alzheimer's drug Aduhelm for patients in clinical trials. [ABSTRACT FROM AUTHOR]

More than 13.8 million people have signed up for ACA coverage for 2022 just ahead of the Jan. 15 open enrollment deadline, according to the latest federal figures. [ABSTRACT FROM AUTHOR]

Tenet's ambulatory surgery subsidiary is the chain's "gem for the future" and on track to claim the majority of the company's adjusted EBITDA mix in the next few years, CEO Suam Sutaria said at the virtual conference. [ABSTRACT FROM AUTHOR]

The Biden administration is reminding insurers of their requirements under the ACA to fully cover contraception after reports of payers flouting the law. [ABSTRACT FROM AUTHOR]

Insurers and group health plans must cover at least 8 at-home COVID-19 tests for each covered individual per month starting on Saturday, new guidance from CMS says. [ABSTRACT FROM AUTHOR]

CMS is proposing to have Medicare cover controversial Alzheimer's disease drug Aduhelm, but only for patients in qualifying clinical trials. [ABSTRACT FROM AUTHOR]

HHS Secretary Xavier Becerra is asking CMS it take another look at 2022 Part B premium hikes now that Biogen cut the price of its controversial Alzheimer's disease drug Aduhelm in half. [ABSTRACT FROM AUTHOR]

CMS wants Part D plans to apply price concessions they get from drugmakers to the point-of-sale to ensure maximum benefit for consumers, according to a major proposed rule. [ABSTRACT FROM AUTHOR]

Medicare Part B spending in 2020 on lab tests increased slightly to $8 billion in 2020 thanks to $1.5 billion in new spending for COVID-19 tests. [ABSTRACT FROM AUTHOR]

CMS has pulled a controversial Trump-era model that would have tied Medicare Part B drug reimbursements to prices paid by countries overseas. [ABSTRACT FROM AUTHOR]

Medicaid and CHIP enrollment increased by more than 400,000 from May to June 2021 and has increased 17% since February 2020, new federal data show. [ABSTRACT FROM AUTHOR]

Democrats are debating what healthcare items to drop in a narrower Build Back Better Act after objections from moderate Sen. Joe Manchin. [ABSTRACT FROM AUTHOR]

President Biden has admitted that a massive $2 trillion healthcare and social spending bill likely will not make it through Congress by Christmas. [ABSTRACT FROM AUTHOR]

Roughly 40% of healthcare payments were tied to an alternative payment model last year, with Medicare Advantage plans shifting the most payments to such models. [ABSTRACT FROM AUTHOR]

CMMI officials are hoping to get more safety-net providers involved in value-based care, but understand they must adjust financial risk metrics in order to do so. [ABSTRACT FROM AUTHOR]

HHS will distribute $9 billion in COVID-19 relief dollars primarily to smaller providers hit hard by the financial crisis caused by the pandemic. [ABSTRACT FROM AUTHOR]

Democratic senators want the Biden administration to go after insurers that flout the ACA's requirements to offer birth control without cost sharing. [ABSTRACT FROM AUTHOR]

A new study from the Urban Institute found nearly 13 million people had problems before the pandemic getting access to prescription drugs as Congress considers major reforms. [ABSTRACT FROM AUTHOR]

A new study found the Independence at Home payment model did not yield a statistically significant decline in Medicare spending or quality targets. [ABSTRACT FROM AUTHOR]

Provider groups are clamoring for the Biden administration to walk back several controversial provisions in an interim final rule on surprise billing, including a requirement for providers to give estimates for care to certain patients. [ABSTRACT FROM AUTHOR]

Provider groups are clamoring for the Biden administration to walk back several controversial provisions in an interim final rule on surprise billing, including a requirement for providers to give estimates for care to certain patients. [ABSTRACT FROM AUTHOR]

The House passed legislation to delay 6% in cuts to Medicare payments that are expected to take effect next year and delays for a year the start of an oncology model. [ABSTRACT FROM AUTHOR]

A new HHS study found that telehealth use in traditional Medicare increased 63-fold in 2020 compared to 2019, but did not fully offset a decline in healthcare utilization fueled in part by the pandemic. [ABSTRACT FROM AUTHOR]

Medicare physician fee service claims spending dropped by nearly $14 billion in 2020 due to the pandemic, a new AMA study finds. [ABSTRACT FROM AUTHOR]

Provider groups slammed the House for not delaying nearly 10% in Medicare payment cuts in a must-pass spending bill, as concerns mount the cuts could go through next month. [ABSTRACT FROM AUTHOR]

The PCMA pulled a federal lawsuit that challenged a Trump administration rule that required PBMs to publicly release drug rebate amounts. [ABSTRACT FROM AUTHOR]

CMS is asking for stakeholder feedback on how to improve health equity in organ transplantation and boost access to dialysis care. [ABSTRACT FROM AUTHOR]

President Joe Biden is expected to call for commercial insurers to cover at-home COVID-19 tests as part of an effort to combat the omicron variant. [ABSTRACT FROM AUTHOR]

Amgen became the latest drugmaker aiming to cut off sales of 340B-discounted products to contract pharmacies, prompting an advocacy group to ask the federal government to step up enforcement. [ABSTRACT FROM AUTHOR]

Supreme Court justices grilled key parts of HHS' arguments over its bid to keep a nearly 30% cut to Medicare drug reimbursements for 340B hospitals. [ABSTRACT FROM AUTHOR]

The Center for Medicare and Medicaid Innovation has chosen to withdraw the seriously ill population component of the Primary Care First payment model due to concerns it can't get enough beneficiaries to participate. [ABSTRACT FROM AUTHOR]

Anesthesiologists are charging that Blue Cross Blue Shield of North Carolina is using strong-arm tactics to force pay cuts to physicians as part of implementation of the No Surprises Act. [ABSTRACT FROM AUTHOR]

UCB became the ninth drugmaker to cut off sales of 340B-discounted products to contract pharmacies despite an ongoing legal feud between several drugmakers and the federal government. [ABSTRACT FROM AUTHOR]

A Bloomberg survey of 25 major insurers found that none of the payers believe it's medically necessary to cover a controversial Alzheimer's drug made by Biogen. [ABSTRACT FROM AUTHOR]

The House passed a massive roughly $2 trillion infrastructure bill that includes drug price reforms, closes the Medicaid coverage gap and cuts DSH payments to hospitals in states that did not expand Medicaid. [ABSTRACT FROM AUTHOR]

So far, more than 1.6 million people have signed up for Affordable Care Act coverage during the first two weeks of 2022 open enrollment, new data from CMS show. [ABSTRACT FROM AUTHOR]

A new analysis finds that providers could face a nearly 40% cut to their Medicare Part B reimbursements if Medicare gets the power to negotiate prices over certain products. [ABSTRACT FROM AUTHOR]

A new analysis found that fewer providers in rural and underserved areas participated in advanced alternative payment models over a two-year period, with high costs and unpredictable requirements key challenges. [ABSTRACT FROM AUTHOR]