Category: News

March 13, 2025

Alex Kacik  

Hospitals could lose billions of dollars in revenue if states roll back Medicaid expansions due to potential Medicaid cuts.

House Republicans proposed hundreds of billions of dollars in Medicaid cuts, potentially including per capita caps, work requirements and eliminating enhanced federal payments for states that expanded Medicaid coverage. Hospitals may lose $32 billion in 2026 revenue if Medicaid expansion is curtailed, an analysis released Tuesday by the left-leaning think tank Urban Institute shows. Coverage losses could also increase providers’ uncompensated care costs.

March 03, 2025

Lauren Berryman   

UnitedHealth Group is taking another step to refine its prior authorization requirements as it continues to face public frustration. The healthcare giant’s insurance business, UnitedHealthcare, plans to cut nearly 10% of prior authorizations this year, the company said in a notice Saturday.

As part of the initiative, the insurer said it will remove pre-approval requirements for home health services managed by its home and community division. The changes will apply to Medicare Advantage and dual special needs plans in 36 states and Washington, D.C., starting April 1.

February 19, 2025

Nona Tepper  

Health insurance customers in more parts of the country have new advocates in their battles against claims denials: state governments.

States have long had regulatory authority over the individual and small-group health insurance markets, but a growing number of agencies is taking on a greater role assisting consumers as they transition out of a federal system and take matters into their own hands.

State officials see homegrown solutions as more effective at handling large numbers of complaints. Pennsylvania, for instance, established an independent external review board in 2024 while Arizona launched a program at the start of this year.

February 11, 2025

Michael McAuliff   

Lawmakers say they are confident Congress will extend expanded telehealth authorities past a looming deadline next month — but they have no idea how and could not rule out a lapse.

In 2020, Congress and President Donald Trump temporarily expanded Medicare reimbursement for services clinicians provide remotely as part of the response to the COVID-19 pandemic. Lawmakers have hailed extended telehealth rules for providing lifelines to rural and underserved populations in particular, prompting some to propose bills last year to make the changes permanent.

January 29, 2025

Nona Tepper  

Promising signs for “public option” health plans sold on state health insurance exchanges spell bad news for providers, who say they’re squeezed by low reimbursements.

Colorado and Washington are the only states that have government-sponsored — but privately administered — public options on their marketplaces. Nevada is set to join them soon and other states may follow. Public option enrollment climbed on Connect for Health Colorado and Washington Healthplanfinder during the open enrollment period that ended Jan. 15, the states reported.

January 22, 2025

Nona Tepper  

Healthcare providers say insurance companies are innovating new ways to make it harder to get paid.

Physicians, hospitals and other providers have always complained of low rates, delayed payments and the usual red tape. But rules insurers such as Blue Cross Blue Shield of Michigan, UnitedHealthcare and Elevance Health have recently announced may be a new battleground in the age-old fight between the two camps.

Health insurance companies justify utilization management and claims review as crucial to constraining healthcare spending and ensuring that patients receive appropriate care.

January 15, 2025

Bridget Early   

The Drug Enforcement Administration is proposing a rule in the Biden administration’s final days that would establish a special registration process for remote prescribing of certain drugs.

On Wednesday, the DEA released a proposed rule that would set up a special registration process for remote prescribing of Schedule II-V controlled substances such as Xanax, Vicodin and Adderall. It also released a final rule for its 2023 proposal that sets up a special registration process for remote prescribing of buprenorphine, a medication used to treat opioid use disorder.

January 07, 2025

Lauren Dubinsky  

Stryker plans to acquire Inari Medical in a deal valued at $4.9 billion and designed to strength its position in the peripheral vascular market.

The deal, announced Monday and approved by both companies’ boards, is expected to close by the end of the first quarter. Stryker will purchase Inari’s common stock for $80 per share. 

Inari Medical’s product portfolio includes medical devices that treat pulmonary embolism, deep vein thrombosis, in-stent thrombosis and arteriovenous fistula. Stryker said the products are “highly complementary” to its neurovascular business.

November 19, 2024

Airielle Lowe, Bloomberg

President-elect Donald Trump is nominating celebrity doctor and television personality Mehmet Oz to lead the Centers for Medicare and Medicaid Services.

“America is facing a Healthcare Crisis, and there may be no Physician more qualified and capable than Dr. Oz to Make America Healthy Again,” Trump said in a statement Tuesday. “Dr. Oz will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex, and all the horrible chronic diseases left in its wake.”  The celebrity doctor ran for Senate in Pennsylvania in 2022, and with Trump’s endorsement defeated former Bridgewater Associates chief executive officer Dave McCormick in a fiercely contested Republican primary before losing to Democrat John Fetterman in the general election.