CMS recently issued a proposed rule to implement changes to the Qualified Entity Program, established by the ACA and expanded by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The rule would allow qualified entities (which are certified by CMS to access Medicare, Medicaid and CHIP claims data to conduct combined analyses with other claims data) to provide or sell data and analyses to “authorized users.” Health insurers would be considered authorized users under the health i...

NHCAA has submitted a letter of comment in response to CMS publishing on June 1, a long-awaited proposed rule that aims to overhaul regulatory oversight of Medicaid managed care. Our comments focus on medical loss ratio and compliance program requirements.

On July 22, NHCAA Board Chair Katherine Leff (SIU Director, CareSource) testified as part of a three-person panel before the Senate Special Committee on Aging at a hearing titled, "The Doctor's Not In: Combating Medicare Provider Enrollment Fraud." Ms. Leff was joined on the witness panel by Shantanu Agrawal, M.D., CMS Deputy Administrator and Director of the Center for Program Integrity (CPI) and Seto Bagdoyan, Director of Audit Services , Government Accountability Office.

The U.S. Supreme Court has ruled 6 to 3 on King v. Burwell, a case challenging the Affordable Care Act (ACA). The central question in the case was whether the IRS may permissibly promulgate regulations to extend tax-credit subsidies to coverage purchased through exchanges established by the federal government under Section 1321 of the Patient Protection and Affordable Care Act. The ruling, a victory for the Obama Administration, means that individuals who get their health insurance through an...

On June 23, the Department of Health and Human Services (HHS) Office of Inspector General issued two reports of interest: "Ensuring the Integrity of Medicare Part D."