Reimbursement

The Centers for Medicare & Medicaid Services (CMS) has tentatively given an OK for regulators in Maine, South Dakota and Virginia to certify and oversee qualified health plans (QHPs) that will be sold in the federally-facilitated exchanges in those states.

Maryland officials have proposed what analysts call the most ambitious initiative in the country to control soaring medical spending, a plan that would bring relief to employers and consumers footing the bill while bluntly challenging the state's powerful hospital industry.

Louisiana Department of Health and Hospitals Secretary Bruce Greenstein is resigning on May 1, amid state and federal investigations into a $185 million Medicaid contract awarded to a company where he briefly worked.

After news broke of Health and Human Services Secretary Kathleen Sebelius tentatively approving Arkansas' idea for expanding Medicaid via premium support for private health plans in an insurance exchange, some were wondering if HHS even had the legal authority to do it.

While the Affordable Care Act's individual mandate was naturally expected to drive the previously uninsured to non-group plans, it has become increasingly clear that the individual market is also bracing for a potentially significant influx of currently insured enrollees who are driven there both by choice and necessity.

State health insurance exchanges are putting together financing and revenue sources, with many likely relying on insurer fees, as long-term state or federal support remains uncertain.

Highmark Inc. has unveiled a new group health plan that provides incentives for members to use providers that exhibit higher quality outcomes, fewer complications and reduced readmissions.

It's often been said that almost everyone has a smartphone. Unfortunately, not everyone has the financial resources to use it.

Hundreds of thousands of Medicare beneficiaries in almost 100 counties across the United States and its territories will be losing coverage for telehealth services because they no longer live in federally designated rural areas.

California's three-year demonstration program for Medicare-Medicaid dual eligibles has been approved by the federal government.