Federal & State Policy
As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal and state policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Featured Content
California Becomes the 6th State to Restrict Short-Term Plans in 2018
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.
2019 Premium Increases Lowest on Average Since 2015
Average premiums projected to grow 3.1% heading into next year.
CMS Proposal Would Alter Office Visit Payments
In its proposed changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year 2019 (CY2019), the Centers for Medicare & Medicaid Services (CMS) proposes a potentially sweeping change to the way it values physician office and outpatient visits, also known as Evaluation & Management (E/M) codes.
Medicare Advantage Achieves Better Health Outcomes and Lower Utilization of High-Cost Services Compared to Fee-for-Service Medicare
New research from Avalere finds that Medicare Advantage (MA) beneficiaries with hypertension, hyperlipidemia, and diabetes experienced significantly fewer inpatient stays and emergency room visits relative to those in traditional fee-for-service (FFS) Medicare.
CMS Rejects Massachusetts’ Medicaid Closed Formulary Proposal
On June 27, CMS notified Massachusetts of a partial approval of the MassHealth program’s proposed 1115 waiver request.
Final Rule Lowers Barriers to Forming and Joining Association Health Plans
On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).
Double-Digit Premium Increases Expected in the Exchange Market in 2019
2019 rate filings suggest increased competition and plan choice
CMS Expands Benefit Flexibilities in Medicare Advantage
Earlier this year, the administration granted Medicare Advantage plans greater flexibility to target benefit designs for individuals with certain high-risk health conditions. These changes are expected to position the program for continued growth.
Medicare Trustees Report Triggers Program Funding Warning
In its 2018 Report, the Medicare Trustees issued a Medicare funding warning, citing concerns over the program's near-term financial health and spending impact on the federal budget.
Seniors Pay More for Medicare Part D Generics Despite Stable Prices
Avalere analysis finds that price of generic drugs has remained flat but the cost to seniors is increasing.
More Medicare Part D Enrollees Are Reaching Catastrophic Coverage
Patient out-of-pocket costs continue to grow despite policies to increase affordability for beneficiaries.
The Medicare Advantage Factor in Assisted and Senior Living Facilities
Avalere's founder and president, Dan Mendelson, recently sat down with Senior Housing News editors to discuss opportunities for senior living providers to leverage data to facilitate synergistic partnerships with payers.
Use of Step Through Policies for Competitive Biologics Among Commercial US Insurers
Avalere evaluated payer policies for biologics when biosimilars are available.
Patient Out-of-Pocket Assistance in Medicare Part D: Direct and Indirect Healthcare Savings
Avalere examines the effect of foundation-sponsored financial assistance on out-of-pocket costs and federal spending.
CMS Gives More Flexibility to States When Regulating Health Insurance
The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.
Two-Year Countdown Begins for FDA “Roll-Over” of Biologics Currently Regulated as Drugs
In just two years, on March 23, 2020, biologics currently regulated as drugs will transition to being regulated as biologics. Many aspects of how FDA will implement this transition have yet to be established.
Adapting to Medicaid Changes and Trends in 2018
On March 6, Avalere experts came together to discuss the latest Medicaid developments.
Medicare Patients Are Using Fewer Skilled Nursing Services
New research from Avalere finds Medicare beneficiaries are spending fewer days in skilled nursing facilities (SNFs) since 2009 on a per capita basis.
Webinar: Medicaid: Adapt to the Changes
Avalere experts discuss an evolving Medicaid program supported by a new administration and novel state approaches.
Association Health Plans Projected to Enroll 3.2 Million Individuals
New analysis from Avalere finds that the proposed rule on association health plans (AHPs) is projected to lead to 3.2M enrollees shifting out of the Affordable Care Act's (ACA) individual and small group markets into AHPs by 2022.