Policy and Legislation

Among the major changes proposed for Medicaid plans are new provider adequacy standards, new mandates for capitated rate setting, beneficiary protections in long-term care, forthcoming quality ratings, and an 85 percent medical cost administrative ratio.

Depending on how much the program is reformed, it could mean the difference of hundreds of millions of dollars for the thousands of hospitals who get a drug discount.

The decline of CoOportunity Health of Iowa and Nebraska has Obamacare critics and executives at large insurers skeptical that co-ops can ever compete.

With the Oncology Care Model, participating practices will have their chemotherapy treatments tracked and measured for the necessity and outcome of the treatment, as well as the coordination of care that leads up to the cancer treatment.

"Instead of imposing this unfunded mandate, Congress should delink the disease classification system from reimbursement policy, and make the adoption of the new ICD-10 code system voluntary until a less burdensome billing process is in place," The Heritage Foundation wrote in a May 18 report.

Assistant Secretary Jan Frye claims VA improperly spent at least $5 billion a year on medical equipment, sparking inquiry.

Steven Stack, the incoming president of the American Medical Association, says problems with ICD-10 for physicians are too big to allow it to move forward.

In a letter to House leadership, Rep. Scott Peters, D-Calif. and 17 other Democrats are calling for lawmakers to act quickly on a bill repealing the medical device tax before Memorial Day.

States that expand get billions of additional federal dollars, but many Republican lawmakers are loathe to say yes to the Obama administration.

Study by Standard & Poor's finds a number of provider-owned health plans and cooperative insurers may not get the funding they had hoped for.