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[Guidance Overview]
'Pathways to Success' Update: CMS Issues Final Rule on Changes to the ACO Program
"On December 21, 2018, CMS issued the final rule for the redesign of the [Medicare Shared Savings Program (MSSP) which] includes the following: [1] Greater savings for one-sided risk models.... [2] Qualification as a low revenue ACO.... [3] Additional year of one-sided risk for new low revenue ACOs.... [4] High revenue ACO participation in BASIC Track Level E.... [5] Repayment mechanism for two-sided risk.... [6] Benchmarking methodology."
Sheppard Mullin
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[Guidance Overview]
CMS Finalizes Proposed Redesign to Medicare Shared Savings Program
"Low-revenue ACOs are permitted to stay in one-sided risk-sharing models for a longer period ... Any ACO determined to be experienced with Risk Models however, is required to take on risk immediately.... CMS is also cutting the shared savings rate that will be available for ACOs until they enter a Risk Model.... CMS finalized modifications to its calculation of the regional adjustment to an ACO's performance benchmark[.]"
K&L Gates
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Drug Costs Driven Largely By Price Increases, Not Innovation
"[T]he cost of brand-name oral prescription drugs rose more than 9 percent a year from 2008 and 2016, while the annual cost of injectable drugs rose more than 15 percent.... [I]ncreases in prices of brand-name drugs were largely driven by year-over-year price increases of drugs that were already in the market[.]"
National Public Radio [NPR]
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New State Laws Require More Preventive Services From Insurers
"A bevy of new state laws pertaining to health insurers took effect Jan. 1. It all adds up to a year of potentially higher costs for plans, with some states entering 2019 by protecting various [ACA] provisions by statute -- and even more of them eying how to take advantage of the ACA's state innovation waivers as the year progresses."
AISHealth
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Digital Health Promises Remain Unfulfilled for High-Need, High-Cost Populations
"[Of] the studies conducted on digital health products and services, most enrolled healthy volunteers. Few enrolled high-burden, high-cost patients ... Healthy volunteers made up 32% of the studies, followed by patients with amyotrophic lateral sclerosis (14%) and those with multiple sclerosis 12%. Mental health was the most common high-burden condition category studied ... There were no studies for lung cancer or smoking."
American Journal of Managed Care
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Democrat States, DOJ Appeal Texas ACA Case to Fifth Circuit
"[T]he case is expected to live or die based on what the Fifth Circuit, and ultimately the Supreme Court, decide on the constitutionality of the mandate and severability. This likely makes the House's motion to intervene in the district court case largely symbolic ... In any event, this part of the lawsuit is stayed until after the appeal on the first claim and will not be at issue until at least 2020."
Katie Keith, in Health Affairs
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Selected Discussions on the BenefitsLink Message Boards
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HRA, FSA, and HSA at the Same Time?
If you follow the guidelines, you clearly can have any two out of the three at the same time. If your FSA is limited purpose, and your HRA is set up to only pay after reaching the deductible of $1,350/$2,700, is there any reason you can't have all three?
BenefitsLink Message Boards
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5500 Newbie Has Question About Question 8a
Am doing a 5500-SF filing for a "one-participant" plan -- 2 sibling partners in a general partnership with 2 self-employed 401(k)s that use the EIN of the partnership. For question 8a on 5500-SF, is the employee contribution of up to $18,500 per person (in 2018) to 401k go to 8a(2) participants and the 20-25% go to employee amount go to 8a(1) employers.... or does IRS want "one-participant" plans to lump all 401k (employer and employee) contributions to 8a(2) participants because it is not a "single employer plan"?
BenefitsLink Message Boards
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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.
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