Congress Considers Fixes For Medicare Advantage Prior Authorization
A bill that would speed up the prior authorization process and demand more transparency when insurance plans deny health provider's requests was reintroduced Thursday. Separately, Mayo Clinic and Kaiser Permanente plan to boost hospital care in patient's homes, and Connecticut's nursing home workers postpone strikes.
Modern Healthcare:
Bill Would Revamp Medicare Advantage Prior Authorization
Congress is eying changes to Medicare Advantage that would crack down on prior authorization tactics insurers use to rein in healthcare costs but can affect how providers care for patients. Rep. Susan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.) reintroduced a bill Thursday that aims to quicken the prior authorization process and require more transparency about how often plans deny providers' requests. Healthcare lobbyists believe the proposal could see movement this year. (Hellmann and Tepper, 5/13)
Modern Healthcare:
CMS Guides States On Securing Funding For Home- And Community-Based Services
CMS on Thursday issued guidance to states on how they can get additional federal funding to increase access to home and community-based services for Medicaid beneficiaries. Congress temporarily increased states' federal matching funds for such benefits by 10% in March's $1.9 trillion COVID-19 relief package, also known as the American Rescue Plan. The funds should help Medicaid beneficiaries maintain access to long-term services and support in their home and other nearby care settings. (Brady, 5/13)
In corporate news —
Axios:
Mayo Clinic And Kaiser Permanente Team Up To Scale Hospital-At-Home
Mayo Clinic and Kaiser Permanente announced Thursday they've teamed up to scale the use of hospital care in patients' homes, starting with a shared investment in Boston-based company called Medically Home Group. After seeing hospital capacity strained to the max amid the pandemic along with the simultaneous rise of telehealth, more patients could find themselves getting acute care in their own beds in the future. (Reed, 5/13)
Modern Healthcare:
Cedar Pays $425 Million To Buy Insurance Fintech Platform
Healthcare fintech provider Cedar paid $425 million to acquire insurance fintech OODA Health on Thursday, in another example of single-point technology startups coming together to expand their reach. The New York City-based Cedar provides a direct-to-consumer platform that providers can use to translate to consumers how much they will be billed after a visit, and create custom payment plans based on individuals' credit history. OODA Health, meanwhile, offers the same service to insurer members. The combined company will use insights gained from both providers' and payers' perspective to build additional products to help insured patients the financial responsibility related to their benefits, navigate "administrative resolution" processes, automate prior authorization and more going forward, Cedar CEO Florian Otto said. (Tepper, 5/13)
Modern Healthcare:
Piedmont Healthcare Grabs Market Share In Back-To-Back Hospital Deals
HCA Healthcare and University Health didn't see a way to meaningfully expand their market share in the competitive Atlanta market, leading to a string of recent hospital deals that are poised to benefit Piedmont Healthcare, merger and acquisition experts said. Piedmont will add seven hospitals to its current 11-hospital footprint via back-to-back transactions, courtesy of HCA and University Health. HCA sold its last Atlanta-area hospital to AdventHealth Thursday. (Kacik, 5/14)
In other health care industry news —
Stat:
Charles River Loses A Battle Over Harvesting Horseshoe Crabs For Testing
In a setback to Charles River Laboratories (CRL), a federal judge temporarily blocked its contractors from commercially harvesting horseshoe crabs — whose blood is used for reagents — from a national wildlife refuge because the federal government did not properly authorize the work. The preliminary injunction was issued in a lawsuit filed by an environmental group that claimed the harvesting harms the crabs and threatens migratory birds that depend on crab eggs. (Silverman, 5/13)
AP:
Connecticut Nursing Home Workers Postpone Planned Strikes
Unionized nursing home workers agreed to postpone strikes planned for Friday at 26 facilities across Connecticut after Gov. Ned Lamont’s administration reached an agreement with union leaders and nursing homes operators that includes $267 million in state funds to help pay for historic wage increases. The workers including nurses, nurses aides, housekeeping staff and laundry workers have threatened to walk out over what they call poverty-level wages and dangerously low staffing levels. (Haigh, 5/14)
