Reimbursement
Expenses continue to rise as hospitals replenish staff to meet rising coronavirus cases and incur the costs of drugs and PPE.
Some 30 insurers are entering the individual market, and an additional 61 are expanding their service area within states, a KFF report says.
States, as Georgia has done, could waive certain ACA requirements to develop their own state healthcare programs.
Risk adjustment data validation ensures payment integrity and accuracy – and it affects what plans are paid.
Barring an appeals court decision overturning the rule, the mandate goes into effect on January 1, 2021.
PhRMA questions the cost savings and says the rule leaves safety considerations to state governments, rather than the required federal oversight.
The interim rule would cut drug reimbursements to hospitals by an average of 65% when fully phased in, the AHA says.
The old federal regulations burdened providers with added administrative costs and fear of financial consequences, CMS says.
Opponents say the rule will not lower drug prices, and some question whether it is legal, having bypassed the public comment process.
The letter warns that the new thresholds are too high and will force many clinicians to exit from APMs and revert back to fee-for-service.