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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WellCare to buy Meridian Health Plans for $2.5B

One of the largest insurers in the U.S. behind the Big Five of UnitedHealthcare, Aetna, Anthem, Cigna and Humana, WellCare would add more Medicaid and Medicare Advantage (MA) members with the purchase of Meridian Health Plans.

FDA approves AI software to detect wrist fractures

The Food and Drug Administration (FDA) gave software company Imagen permission to market its artificial intelligence (AI) diagnostic system OsteoDetect.

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California’s rate-setting bill shelved

The legislation, sponsored by California Assemblyman Ash Kalra, a Democrat from San Jose, would have created a state commission to set rates for many medical services currently covered by private insurers in the group and nongroup markets.

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Insurers’ secretive deals with hospitals can force patients to pay exorbitant rates

Michael Frank has worked for health insurance companies for decades, doing the actuarial science which determines how much people should pay in monthly premiums. He knows insurers are supposed to be his “advocate” to restrain costs and get him a fair rate—so he was shocked when Aetna agreed to pay $70,000 to NYU Langone Medical Center in New York City for his partial hip replacement.

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CMS’s direct provider contracting model draws mixed response

CMS had requested comments on allowing direct provider contracting (DPC) with Medicare beneficiaries in the form of the alternative payment model. Among major healthcare groups, the response was decidedly mixed, ranging from cautious optimism to telling CMS to focus on other payment reforms.

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What conservative groups want from another ACA repeal effort

Calling 2017’s failed efforts to repeal the Affordable Care Act “one of the greatest disappointments to conservative and libertarian activists in history,” conservative groups pushed for another attempt at getting rid of the law with a series of principles they want to see enacted in place of the ACA.

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Partners finalizes merger agreement with Care New England

The deal will still need to be approved by federal and state regulators, but after delays in contract talks and an unsolicited bid from Brown University, the agreement advances Partners HealthCare’s aim of expanding beyond Massachusetts and matching the increased scale of other Boston-based health systems.

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How is Anthem’s outpatient imaging policy being received in Colorado?

Anthem’s controversial policy of pushing outpatient imaging not deemed medically necessary out of hospitals went into effect in Colorado in September 2017.