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HHS Failed To Conduct Required Visits Of Independent Living Programs For People With Disabilities, Inspector General Finds

August 14, 2019 Morning Briefing

Meanwhile, hospitals and health systems are pushing the Centers for Medicare & Medicaid Services to set national rules for how insurers manage prior authorization and payment for pre-approved Medicare Advantage claims. Also, the administration is slow to implement a five-year-old law to curb unnecessary Medicare CT scans, MRIs and other tests. Agency news comes from the Food and Drug Administration, also.

Analysis: Choosing A Plan From The Impossible Health Care Maze

By Elisabeth Rosenthal December 6, 2019 KFF Health News Original

In 21st-century US health care, everything is revenue, and so everything is billed.

No More Secrets: Congress Bans Pharmacist ‘Gag Orders’ On Drug Prices

By Susan Jaffe October 10, 2018 KFF Health News Original

Congress approved two bills last month that prohibit provisions keeping pharmacists from telling patients when they can save money by paying the cash price instead of the price negotiated by their insurance plan.

Democratic-Leaning Group’s Ad Suggests Trump Cut Medicare To Pay For Tax Breaks To Billionaires. That’s Not True.

July 24, 2019 Morning Briefing

The Washington Post Fact Checker blasts the claim. While President Donald Trump’s 2020 budget did propose reductions in anticipated spending on Medicare, it was completely unrelated to the tax cut passed by Congress in 2017. In other news, HHS Secretary Alex Azar suggests that Medicare Advantage plans could see pay boosts.

No Gaps In Understanding: Here’s Your Primer On Medigap Coverage

By Judith Graham July 26, 2018 KFF Health News Original

Seniors often don’t realize that private insurers are required to offer Medigap policies, or supplemental insurance, only when people first sign up for Medicare.

Adultos mayores vulnerables logran volver a ser independientes

By Judith Graham January 31, 2019 KFF Health News Original

El programa para personas mayores vulnerables de bajos ingresos Community Aging in Place — Advancing Better Living for Elders (CAPABLE) ayuda a los abuelos a vivir independientemente.

Medicare Cuts Payments To Nursing Homes Whose Patients Keep Ending Up In Hospital

By Jordan Rau December 3, 2018 KFF Health News Original

The incentive program to discourage nursing homes from discharging patients too quickly will also give bonuses to facilities with fewer rehospitalizations.

Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit

By Chad Terhune Photos by Heidi de Marco January 3, 2019 KFF Health News Original

Managed-care plans, which reap billions in taxpayer dollars to coordinate care for low-income Americans on Medicaid, outsource crucial treatment decisions to subcontractors that aren’t directly accountable to the government. In California, health officials say one firm improperly withheld or delayed care for hundreds of people.

Feds Pave The Way To Expand Home Dialysis — But Patients Hit Roadblocks

By Judith Graham August 22, 2019 KFF Health News Original

What changes are needed to bring home dialysis to more patients — especially older adults, the fastest-growing group of patients with serious, irreversible kidney disease? We asked nephrologists, patient advocates and dialysis company officials for their thoughts.

California Surprise-Billing Law Protects Patients But Aggravates Many Doctors

By Michelle Andrews December 5, 2019 KFF Health News Original

A California law, which took effect in July 2017, protects consumers who use an in-network hospital or other facility from surprise bills when cared for by an out-of-network doctor. But physicians say the law has allowed insurers to shrink networks, limiting access to those doctors who have contracted with the patients’ insurance plans.

Medicare reduce pagos a hogares cuyos pacientes vuelven a ser hospitalizados

By Jordan Rau December 3, 2018 KFF Health News Original

El gobierno federal reducirá los pagos de un año a casi 11,000 hogares cuyos pacientes vuelven al hospital con demasiada frecuencia.

Research Roundup: Medicaid Expansion, Health Law Repeal And Medicare Advantage Plans

April 11, 2019 Morning Briefing

Each week, KHN compiles a selection of recently released health policy studies and briefs.

CMS To Give Medicare Advantage Plans A Pay Boost Along With More Flexibility

April 2, 2019 Morning Briefing

“These changes to the model better reflect costs and improve the financing for the care of beneficiaries with multiple conditions,” said CMS Administrator Seema Verma.

Trump Administration Moves To Make Health Care Costs More Transparent

By Julie Appleby July 31, 2019 KFF Health News Original

The proposed rules would require hospitals to provide far more detail about the actual prices they charge insurers for patients’ care.

Readers And Tweeters Slice And Dice Precision Medicine, Step Therapy

September 26, 2018 KFF Health News Original

Kaiser Health News gives readers a chance to comment on a recent batch of stories.

Why The U.S. Remains The World’s Most Expensive Market For ‘Biologic’ Drugs

By Sarah Jane Tribble December 20, 2018 KFF Health News Original

Biologic drugs, made from living organisms, are big moneymakers partly because they have little competition from “biosimilars.” It’s a very different story in Europe.

MedPAC Suggests Streamlining Emergency Department Coding So That There Would Be National Guidelines

April 5, 2019 Morning Briefing

The suggestion from the Medicare Payment Advisory Commission comes as scrutiny of emergency department visits and spending has increased as the healthcare industry shifts towards more value-based care. MedPAC also weighed in on Medicare Advantage payments.

Lethal Plans: When Seniors Turn To Suicide In Long-Term Care

By Melissa Bailey and JoNel Aleccia April 9, 2019 KFF Health News Original

In a nation where the suicide rate continues to climb, such deaths among older adults are often overlooked. A six-month investigation by KHN and PBS NewsHour finds that older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes.

Wisconsin Reinstates Coverage Of Transgender Treatment For State Workers

By Emmarie Huetteman August 29, 2018 KFF Health News Original

The Group Insurance Board reversed a decision made last year to bar coverage of transgender hormone therapy and surgery for public workers.

‘If You Like Your Plan, You Can Keep It.’ Biden’s Invokes Obama’s Troubled Claim.

By Jon Greenberg, PolitiFact July 30, 2019 KFF Health News Original

The health policy landscape is very different than it was when Barack Obama made this pledge as part of his pitch for the Affordable Care Act. But the words still might be risky for Democratic presidential primary hopeful Joe Biden.

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