Amy Lotven

Los Angeles

Senior Editor at Inside Health Policy

LA-based health care reporter with Mid-western roots and split ends. Oft befuddled, never bored.

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Articles

Regulator Presses CCIIO On Broker Reinstatements

1 week ago | insidehealthpolicy.com | Amy Lotven

CMS has reinstated agents and brokers who were suspended from the Affordable Care Act marketplace last year as the agency cracked down on fraudulent enrollment activity -- a move that CMS’ exchange head Peter Nelson says was needed to ensure due process rights -- but that confounded at least one state regulator who viewed it as counter to CMS’ aim to protect consumers. Anita Fox, director of Michigan’s Department of Insurance and Financial Services (DIFS), pressed Nelson on the reinstatements...
Congress Out; Stakeholders Sift Through 5 Pay Regs, MAHA Heads To Indy

1 week ago | insidehealthpolicy.com | Amy Lotven |Jessica Karins

Congress is out this week after successfully moving the budget resolution through both chambers and setting up a Medicaid fight, and stakeholders this week will be digesting the five proposed payment rules CMS unveiled Friday, which included calls for public input on Medicare deregulation and quality reporting measures on nutrition and well-being in the name of the Make America Healthy Again initiative -- all while removing several Biden-era social determinants of health policies.
CMS Draft IPPS Boosts Pay By 2.4%, Seeks Comments On MAHA Reporting Measures

1 week ago | insidehealthpolicy.com | Amy Lotven

CMS is proposing to increase hospital pay by 2.4% or about $4 billion for fiscal 2026 in a draft rule that also proposes to tweak several quality programs by adding Medicare Advantage data and removing measures that refer to health equity or social drivers of health. To advance HHS Secretary Robert F. Kennedy Jr’s Make American Healthy Again agenda, the rule also seeks comments on quality measures for well-being and optimal nutrition; and the draft rule includes requests for information...
Hospitals Hit Back As Conservatives Target Medicaid ‘Financing Gimmicks’

1 week ago | insidehealthpolicy.com | Amy Lotven

As stakeholders on and off Capitol Hill look to end or reduce states’ ability to tax providers to draw down additional federal Medicaid funds and boost reimbursement, hospitals are hitting back -- arguing that people who characterize complex, yet legal, state financing methods as nefarious budget gimmicks are only trying to mask their goal to cut the Medicaid program.
CMS Cuts Off Federal Match For Non-Health Related Medicaid Initiatives

2 weeks ago | insidehealthpolicy.com | Amy Lotven

CMS informed states Thursday (April 10) the agency will no longer approve requests for Medicaid matching funds to support health or investments programs that are not directly related to health care, underscoring the Trump administration’s plan to focus resources on Medicaid’s core mission of serving traditional beneficiaries.
Court’s Repeal Of Nursing Staff Mandate Sparks Payfor Questions

2 weeks ago | insidehealthpolicy.com | Amy Lotven

Nursing home stakeholders who sued the Biden administration over its staffing mandate rule are celebrating a Texas federal district court’s decision to vacate nationwide key pieces of the regulation, but the ruling also raises questions over whether lawmakers lost a major budget savings opportunity by not repealing the rule legislatively. The Monday (April 7) decision came just days after the Trump administration defended the controversial rule in a separate case in Iowa.
Agents/Brokers Say Dems’ ACA Anti-Fraud Bill Masks CMS’ Oversight Failure

3 weeks ago | insidehealthpolicy.com | Amy Lotven

The lobby representing exchange plan agents and brokers is blasting Democrats’ bicameral legislation that would slap civil or criminal penalties on agents and brokers who submit fraudulent information, saying the bill masks the federal government’s failure to protect consumers and doesn’t address the root of the problem. “The federal government is pointing fingers at brokers while failing to acknowledge systemic failures that have allowed fraud to flourish.
DOJ Indicts ACA Brokers For $161.9M Enrollment Fraud; Paragon Says Enhanced ACA Credits Should Expire

3 weeks ago | insidehealthpolicy.com | Amy Lotven

The Department of Justice recently indicted two men for allegedly running a scheme to glean commissions by enticing people to misstate their expected income so they could enroll in a subsidized Affordable Care Act plan, a move the Paragon Health Institute highlights as evidence lax verification policies, combined with the enhanced ACA tax credits enacted under the Biden administration, incentivized fraudulent activities, the verification process should be tightened and Congress should let the...
GOP Scrambles On Reconciliation Compromise; Big Rules On Deck

3 weeks ago | insidehealthpolicy.com | Amy Lotven |Jessica Karins

The Senate is expected to get news on reconciliation, the Supreme Court will hear arguments on provider choice and several big rules are on deck in a hectic week in DC, that will also be marked by a Senate confirmation vote for CMS administrator nominee Mehmet Oz on Tuesday. Stakeholders will also continue to digest the massive HHS reorganization plan announced last week . Reconciliation The Senate Parliamentarian is expected to decide shortly whether the Senate can use a...
CCIIO Pledges Flexibility, Sets Sept. 12 Rate Deadline Amid APTC Uncertainty

4 weeks ago | insidehealthpolicy.com | Amy Lotven

INDIANAPOLIS -- The Trump administration’s exchange director, Peter Nelson, told a panel of state insurance commissioners Sunday he is aware of the significant uncertainty regulators and insurers face over the potential expiration of the enhanced Affordable Care Act tax credits, and pledged to do whatever possible to ensure a smooth rate-setting process for plan year 2026 and future years.