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.
With the 2018 mid-term elections weeks away, polls show healthcare is a top issue on the minds of voters.
Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.
MA plans expand coverage of supplemental benefits following administration’s policy change.
New research from Avalere finds that Medicare patients with rheumatoid arthritis (RA) may face higher out-of-pocket costs under a proposal to move Medicare Part B drugs into Part D, absent additional policy change to lower cost sharing in the Part D program.
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.
Average premiums projected to grow 3.1% heading into next year.
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.
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.
On June 27, CMS notified Massachusetts of a partial approval of the MassHealth program’s proposed 1115 waiver request.
On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).
2019 rate filings suggest increased competition and plan choice
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.
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.
Avalere analysis finds that price of generic drugs has remained flat but the cost to seniors is increasing.
Patient out-of-pocket costs continue to grow despite policies to increase affordability for beneficiaries.
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.
Avalere evaluated payer policies for biologics when biosimilars are available.
Avalere examines the effect of foundation-sponsored financial assistance on out-of-pocket costs and federal spending.
The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.
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.