Policy and Legislation

Among the major changes proposed for Medicaid plans are new provider adequacy standards, new mandates for capitated rate setting, beneficiary protections in long-term care, forthcoming quality ratings, and an 85 percent medical cost administrative ratio.

Depending on how much the program is reformed, it could mean the difference of hundreds of millions of dollars for the thousands of hospitals who get a drug discount.

The decline of CoOportunity Health of Iowa and Nebraska has Obamacare critics and executives at large insurers skeptical that co-ops can ever compete.

Meanwhile, proposed legislation could cost physicians more, leading to more alignment with hospitals.

Participants in the program are expected to scale their value-based payments to 30 percent by 2016 and 50 percent by 2018.

Under the provision, CMS could continue to use Medicare Administrative Contractors to "probe and educate" providers on their likely compliance with the two-midnight rule.

Bill calls for stiffer fines for tax delinquent Medicare service providers, keeping reimbursement for acute care providers to 1 percent and by upping premiums for wealthier Medicare beneficiaries.

More than two-thirds of the estimated reduction, or $5 billion, was in states opting to expand Medicaid to uninsured low-income adults.

The consumer demand for price transparency is growing as patients pay more out-of-pocket expenses as deductibles rise.

Average enrollment in company plans was essentially unchanged between 2014 and 2015 at 74 percent of all workers.