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Pricey 'breakthrough' drugs confound Medicaid rate-setting

By Virgil Dickson  |  December 12, 2014

Actuaries say it's getting increasingly difficult to advise states on sound rates for Medicaid managed-care plans because high-priced specialty drugs like Sovaldi continue to hit the market at a rapid clip.

Unless they change, devicemakers may see shrinking profits

By Jaimy Lee  |  October 20, 2014

A leading consulting firm is warning medical-device companies that they either embrace the changes taking place in the global healthcare system or they will face sharply declining operating margins in the years ahead.

UnitedHealth's earnings suggest tame medical spending

By Bob Herman  |  October 16, 2014

UnitedHealth Group's profit per share in the third quarter exceeded Wall Street's estimates in large part because of lower-than-expected medical costs, giving hope for other health insurers that healthcare spending is still being held in check.

Medicare premiums, deductibles won't increase in 2015

By Paul Demko  |  October 09, 2014

Premiums and deductibles for Medicare Part B beneficiaries will remain flat for a second straight year, HHS announced Wednesday. In 2015, seniors with incomes below $85,000 will pay a $104.90 monthly premium and face a deductible of $147.

Rural hospital patients face higher out-of-pocket costs for outpatient services

By Bob Herman  |  October 08, 2014

Medicare patients who receive routine outpatient care such as IV bags and heart tests pay considerably more out of their own pockets at critical-access hospitals than at other general acute-care hospitals, according to a report released Wednesday from HHS' Office of the Inspector General. For some...

Healthcare industry doesn't want unique plan identifiers: WEDI

By Joseph Conn  |  September 29, 2014

When Congress passed the Health Insurance Portability and Accountability Act in 1996, it saw “administrative simplification” as a general benefit and specifically called for the adoption of several national numerical identifiers as a way to boost efficiency, reduce waste and control...

Medicare's Pioneer program down to 19 ACOs after three more exit

Medicare's Pioneer program down to 19 ACOs after three more exit

By Melanie Evans  |  September 25, 2014

Three more accountable care organizations dropped out of Medicare's Pioneer program, which was designed to test the payment and delivery model with a small group of elite providers deemed best prepared to handle the operational demands and financial risks.

CMS seeks to clarify coverage for autism treatment under CHIP, Medicaid

CMS seeks to clarify coverage for autism treatment under CHIP, Medicaid

By Virgil Dickson  |  September 25, 2014

The CMS has moved to clarify confusion about a bulletin it released in July on coverage for comprehensive autism treatment under Medicaid and the Children's Health Insurance Program. Uncertainty centered on whether the CMS was mandating coverage for applied-behavior analysis therapy, a costly...

CMS targets nursing homes' overuse of antipsychotic drugs

CMS targets nursing homes' overuse of antipsychotic drugs

By Sabriya Rice  |  September 22, 2014

The CMS will push nursing homes to reduce their use of antipsychotic medications by 25% by the end of 2015 and plans to incorporate a measure of the drugs' use to its star-rating system for consumers.

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