The Biden Administration recently issued a proposed rule to make it easier for family members of workers offered health insurance at their jobs to qualify for premium tax credits for Marketplace coverage. The proposal aims to address what has been called the “family glitch”. Under the ACA, an individual enrolling in a Marketplace plan is not eligible ...

Executive Summary The California Department of Managed Health Care (“DMHC”) issued a recent guidance interpreting the application of the No Surprises Act (“NSA”)—a new federal law prohibiting out-of-network healthcare providers from balance-billing patients for certain emergency and non-emergency services—in California.  Significantly, when determining which payment and dispute resolution processes will apply in a dispute regarding the value ...

Surprise billing dispute arbiters will need to consider information in addition to median contracted rates for billed items or services, the Centers for Medicare and Medicaid Services said in revised guidance. Providers and health insurers can submit the following types of information to influence arbiters’ decisions on qualifying payment amounts: * Training, experience and quality ...

Americans will be able to find out if they have COVID-19 with a breathalyzer test, the Food and Drug Administration announced Thursday. The FDA granted an emergency use authorization to a test produced by InspectIR Systems that collects a breath sample and analyzes for chemical compounds associated with the coronavirus, the first of its kind to ...

Dive Brief: * The average premium for ACA marketplace coverage dipped 1.8% in 2022 compared with the prior year, an analysis from the Urban Institute, funded by the Robert Wood Johnson Foundation, found. * It’s the third consecutive year average ACA premiums declined, bucking the trend of sustained increases for job-based coverage, which provides insurance to a majority ...

The Biden administration is proposing that acute care hospitals get a 3.2% increase in payments for federal fiscal 2023 and to install new quality measures focused on health equity. The Centers for Medicare & Medicaid Services (CMS) released its proposed Inpatient Prospective Payment System (IPPS) rule and a separate rule for long-term care hospitals. The ...