Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

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Molina won’t rule out return to certain ACA markets

Managed care and Affordable Care Act (ACA) exchange insurer Molina Healthcare said its first quarter profits “exceed expectations” after raising premiums for its marketplace plans by about 60 percent and isn’t ruling out returning to markets in Utah and Wisconsin, where it previously offered coverage.

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Maine’s stalled Medicaid expansion heading to court

Maine became the first state to approve Medicaid expansion at the ballot box. Despite 59 percent of voters approved of expansion, Gov. Paul LePage has taken several steps which have stalled its implementation.

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Envision’s lawsuit against UnitedHealthcare dismissed

Envision had sued the insurer in March, alleging UnitedHealthcare “unilaterally” negotiated payment rates and failed to add Envision physicians to its network after the acquisition of AmSurg in 2016. UnitedHealthcare argued Envision’s emergency room billing practices were “egregious,” but also said the lawsuit itself was a violation of the arbitration provision in their contract.

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FDA releases finalized Clinical Trial Imaging Endpoint Process Standards

The FDA released a finalized industry guidance April 27 that will help sponsors optimize the quality of imaging data obtained in clinical trials that support approval of drugs and biological products.

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3 things to know about CMS payment rules for skilled nursing, inpatient rehab, hospices

CMS published several of its annual proposed Medicare payment rules on Friday afternoon, covering a slew of facilities like nursing homes, hospices, inpatient rehabilitation and psychiatric hospitals. As predicted, the proposed rule also included regulatory changes in line with CMS initiatives on reducing administrative burden and granting patients easier access to their own data.

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California congressman proposes testing automatic enrollment in ACA plans

In states that choose to utilize federal grants for the pilot program, those who don’t want coverage would have to actively opt out of plans within 60 days.

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Jefferson Health, AHRA exec on medical device tariffs and the ‘commoditization’ of imaging

Chris Tomlinson, VP of enterprise radiology at Jefferson Health and finance chair at the Association for Medical Imaging Management (AHRA), spoke with HealthImaging about these issues—and why the "commoditization” of imaging may be at the heart of the problem.

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Hospital M&A activity expected to continue brisk pace in 2018

If the first quarter of the year is any indication, the frantic pace of mergers and acquisitions (M&A) among hospitals won’t be slowing down in 2018. Thirty transactions were announced between January 1 and March 31, an 11 percent increase over the same period in 2017, according to Kaufman Hall.