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CMS Issues Final Rule on Navigators, Risk Corridors for 2015
The CMS on Friday issued its final rule for exchange and insurance market standards for 2015 and beyond, a potpourri of policies that address consumer notices, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), standards for navigators and other consumer assisters, and policies regarding the premium stabilization programs, among others.
The CMS on Friday issued its final rule for exchange and insurance market standards for 2015 and beyond, a potpourri of policies that address consumer notices, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), standards for navigators and other consumer assisters, and policies regarding the premium stabilization programs, among others.
Its navigator standards are likely to anger state officials who have tried to regulate navigators in their jurisdictions but it may bring smiles to insurers who will receive subsidies for high-cost enrollees at lower cost levels.
The agency is sticking by its plans to lessen state control over navigators by preempting state laws, or portions of them, if they “prevent the application of the provisions of Title I of the Affordable Care Act,” the CMS said.
Throughout 2013, numerous, mostly GOP-led states passed laws limiting navigator activities. Such measures included stringent restrictions on the advice navigators can offer consumers.
Read the full story here: http://bit.ly/1sLrGV0
Source: Modern Healthcare
Health Care Utilization and Cost of Diagnostic Testing for Respiratory Infections
September 17th 2025Syndromic reverse transcriptase–polymerase chain reaction tests for respiratory infections were associated with lower health care resource utilization and costs, implicating potential for improved value in patient care.
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AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
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Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
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