HRI regulatory center

HRI regulatory center

HRI regulatory spotlight: Medicaid rule revamps home and community services
A final rule from CMS makes it easier for Medicaid beneficiaries to receive services in their homes and communities, and adds fuel to the rapidly growing long term care industry.
HRI regulatory spotlight: Understanding the 3Rs - risk adjustment, risk corridors, and reinsurance
The ACA’s 3Rs programs protect insurers from the financial effects of adverse selection. HRI provides an overview of the programs and explains why they’re critical to stabilizing the market.
HRI Spotlight: FDA focuses on patient safety as medical devices go wireless
HRI regulatory spotlight: FDA focuses on patient safety as medical devices go wireless
As more medical devices include remote technology, the FDA is advising manufacturers to ensure their products remain safe and effective.
Open for business: Insurers prepare for new consumer market
Implementation challenges, politics, and differing state responses to the Affordable Care Act foreshadow a turbulent beginning for new online insurance exchanges. Yet behind the turmoil, a new way of purchasing healthcare coverage is quickly refashioning the industry, with signs that non-traditional players are poised to gain.
HRI's closer look
Health insurance premiums: Comparing ACA exchange rates to the employer-based market
In 2014 the premiums for state exchange based health plans are comparable to -- and in some cases lower than -- those being offered by employers. The data suggest the new exchanges are competitive with the current insurance market and may open doors for employers as they contemplate future benefits strategies.
Final rules on ACA's employer mandate include new transition relief
The IRS issued final regulations providing guidance on the Affordable Care Act's employer shared responsibility provisions, sometimes called the 'employer mandate' or the 'pay or play' rules.
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The 2012 election lifts the veil of uncertainty about the future of the Affordable Care Act. It will be a sprint to full implementation in 2014, with federal budget constraints placing fresh pressure on the administration to scale back its ambition. Some in the health sector are moving out ahead, pursuing new care and payment models and refocusing attention on customer-oriented service.

Learn more about the healthcare regulatory environment through the following resources:

Week of 04/07/14

  • CMS backtracks on Medicare Advantage payment reductions
  • New painkiller faces opposition from elected officials
  • Federal agencies emphasize risk-based regulation for HIT
  • Focus shifts from design to enforcement under HIPAA audit program
  • Innovative ‘new entrants’ vie for healthcare consumers

Week of 03/31/14

  • ICD-10 delay leaves industry with new questions
  • More states move forward with "alternative" Medicaid expansion
  • Generic drug labeling proposal sparks debate
  • FDA updates food labels to help consumers
  • Industry firsts: J&J, Sanofi Aventis create new C-suite roles for design, patients

Week of 03/24/14

  • Federal government, states extend exchange sign-up period
  • House-passed ‘Doc Fix' includes key Medicare program delays
  • FDA releases guidance on labeling for accelerated approved drugs
  • Concern over rising prices for specialty drugs
  • Congress sets sights on antibiotic resistance

Week of 03/17/14

  • Proposed regulation updates health exchange and insurance market standards
  • Federal government allows new extensions on health coverage
  • CMS expands oversight of narrow networks, navigators
  • Washington state bills seek quality, cost transparency
  • Numerous tools emerge to assist the uninsured

Week of 03/10/14

  • CMS releases final rule on Basic Health Program
  • MinuteClinic’s move to Epic aimed at care coordination
  • CMS shelves changes to Medicare drug program
  • Telemedicine programs result in decreased hospital admissions
  • At South by Southwest Interactive, wearables and digital health dominate

Week of 03/03/14

  • Post-acute, rural provider payments reduced under proposed HHS budget
  • Off-exchange enrollments soaring
  • Insurers move to equalize physician and hospital based payment rates
  • Regulators, drugmakers take a second look at over-the-counter drugs
  • New lab testing technology has the potential for significant savings in time, money
  • Insurers may need more nuanced consumer strategies, HRI study finds

Week of 02/24/14

  • CMS proposes Medicare Advantage cuts, methodology changes
  • FDA turns attention to drug quality
  • CMS faces opposition over Part D rule
  • Cloud technology presents new challenges to providers
  • Trauma patients less likely to be transferred if insured, study finds
  • Samsung and UCSF announce center for digital health innovation

Week of 02/17/14

  • Health industry still waiting on myriad rules under federal review
  • For-profit hospitals get Wall Street approval
  • OIG sets its sights on a wide range of medical services, providers
  • FDA plans extensive review of premarket approval pathways for medical devices
  • Mobile technology program leads to improved outcomes, decreased costs among diabetics

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