Wednesday, August 12, 2015

Developing Issue: CMS and Temporary Privileges

Recently, during a NAMSS hosted webinar, CMS officials specified that in compliance with CMS’ Conditions of Participation, only the hospital governing body can grant privileges and that the process for granting temporary privileges must be the same as the process for credentialing and granting of full hospital privileges. This is in contrast to standards put forth by The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP), and other accrediting bodies.

NAMSS is working to attain clarification on this significant change in CMS’ interpretation of the Conditions of Participation and will be working with our industry partners to address this change. As NAMSS obtains additional information, we will update our members via the NAMSS Blog so please stay tuned.

Monday, August 3, 2015

Health Care Consolidation Continues as Anthem Looks to Merge with Cigna

Following the merger of Aetna and Humana earlier in the month, Anthem announced in late July that it would acquire Cigna. This constitutes one of the largest health insurance mergers and will have ramifications across the health care industry. As reported by the New York Times, "Together, Anthem, which runs Blue Cross plans in 14 states, and Cigna, which offers insurance plans through employers, would have around $115 billion in revenue. Cigna also has 24 million behavioral health customers, nearly 14 million dental care members, eight million pharmacy benefit plan members and 1.5 million Medicare Part D pharmacy customers." (Click here for the full New York Times article)

Insurance companies have cited the need to cut costs and increase access to broad networks as the reasons behind such mergers. However, the Anthem-Cigna merger, coming so close on the heels of other major health insurance industry mergers, faces potential regulatory challenges. For a full description of these potential hurdles, please click here for another helpful article from the New York Times.