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
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.
Congress’ 2018 Budget Includes Updates for Providers
On February 9, the Senate voted to pass the Bipartisan Budget Act of 2018, which funds the government through March 23, lifts spending caps for 2 years, and suspends the debt ceiling until March 2019.
Our Take on the President’s FY2019 Budget Proposal
Today, the Trump Administration released its budget for fiscal year 2019 (FY 2019).
Impact of Coverage Gap Discount Changes in Budget Agreement
Avalere experts provide their insights on what the impact of coverage gap discount changes in budget agreement.
Our Take on the 2019 Advance Notice and Draft Call Letter
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released Part II of the Advance Notice and Call Letter (ANCL), describing the Agency's proposed 2019 payment policies and other policy updates for the upcoming plan year for Medicare Advantage (MA) and Part D plans.
Medicare Part B Payment Increases Will Offset 340B Drug Reimbursement Cuts for 85% of Hospitals
Rural hospitals will see an average 2.7% net increase of Part B payments.
Avalere Analysis Shows That Health Needs and Cost of Medicaid Expansion Populations Grow over Time
Beneficiaries show signs of pent-up demand with acute healthcare needs early in their enrollment, but over time costs increase substantially and shift toward chronic care.
What Are Association Health Plans?
On January 4, the Department of Labor (DOL) issued a proposed rule to allow certain self-employed individuals, small businesses, and large businesses, including as part of a professional/trade organization or chamber of commerce, to band together to provide health insurance for their employees and their dependents.
Final 2018 Exchange Enrollment Numbers
At 100% of the OEP, we are at 96% of total Healthcare.gov enrollment compared to 2017 (8.8M n 2018 compared to 9.2M in 2017).
FDA Prepares for the Next Generation of Regenerative Medicines
In its new regulatory framework for regenerative medicines released in November 2017, FDA takes a flexible approach, creating opportunity for manufacturers.
California, North Carolina, and New York Will See the Largest Provider Payment Cuts and Beneficiary Savings Due to 340B Program Changes
Analysis also finds that 62% of impacted facilities will experience less than a 5% reduction in Medicare Part B revenue due to the drug cuts, but 6% of applicable hospitals will experience cuts greater than 10%.