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CMS proposes small bump in MA payments, sweeping risk adjustment changes
CMS is expecting a small revenue bump of 1.03 percent on average for Medicare Advantage and Part D plans in 2024 as part of a slate of potential risk adjustment and star ratings changes that has some industry leaders concerned. -
New CMS Medicare Advantage audit rule lacks information, Humana execs say
CMS' new Medicare Advantage auditing standards did not include enough information about auditing methods to understand its full impacts, Humana executives said on a Feb. 1 investor call. -
In blow to payers, CMS implements tougher Medicare Advantage audit rule
CMS will implement stricter audits of Medicare Advantage plans, a move that could leave payers on the hook for billions of dollars in repayments to the federal government. -
HHS wants to strengthen contraceptive coverage requirements
HHS is proposing a new pathway for no-cost contraceptive coverage for employees of organizations with religious objections to covering these services. -
Why payers are fretting over a proposed CMS Medicare Advantage rule: 7 things to know
A proposed rule change coming from CMS is making payers nervous. -
Insurers that face the largest potential Medicare Advantage payment clawbacks
The nation's largest insurers are gearing up for upcoming changes to Medicare Advantage risk adjustment rules that could collectively cost them up to $3 billion in returned payments, with Humana potentially facing the biggest penalties, Bloomberg reported Jan. 24. -
Site-neutral payments central to BCBS Association’s $767B savings plan
The Blue Cross Blue Shield Association has released a set of policy proposals it says will reduce U.S. healthcare costs by $767 billion over 10 years. -
AHIP's 'State of the Industry' for 2023: 7 takeaways
AHIP is focused on Medicaid redeterminations and promoting competition in the marketplace for 2023. -
ACO REACH expanding in 2023
Over 700,000 providers and organizations are participating in one of CMS' three accountable-care programs in 2023, the agency said Jan. 17. -
CMS lays out timeline for Medicare drug negotiation provision
Though negotiated prices won't appear until 2026, CMS is starting to implement the first-ever negotiated prices for drugs paid for by Medicare. -
HHS extends COVID-19 public health emergency to April
HHS has extended the COVID-19 public health emergency until April 11. -
CMS needs to improve oversight of Medicare Part B drug payment calculations, OIG report finds
CMS needs better strategies to ensure proper oversight of Medicare Part B drug payment calculations, according to a Dec. 3 report from HHS' Office of the Inspector General. -
New Jersey now requires individual, small business plans to cover abortion care
New Jersey has become the eighth state to require state-regulated health plans to cover abortion services. -
New Mexico proposes health equity-focused Medicaid overhaul: 4 things to know
New Mexico is planning several changes to its Medicaid program, focused on equity and whole-person care. -
Prime Therapeutics joins other PBMs in adding Humira biosimilars
Prime Therapeutics will add Humira biosimilars in the same position in its formulary as the original drug, joining other pharmaceutical benefit managers in announcing similar policies. -
New payer price transparency rules take effect Jan. 1
New requirements for payers under CMS' Transparency in Coverage rule take effect Jan. 1. -
Washington state approved to offer ACA coverage to noncitizens
Washington is the nation's first state to be approved by HHS to offer health and dental ACA coverage to any resident, regardless of immigration status, The Hill reported Dec. 12. -
CMS proposes rule to further overhaul Medicare Advantage marketing, prior authorization
CMS issued a proposed rule Dec. 14 to continue its efforts to overhaul prior authorization and marketing practices around Medicare Advantage and Part D plans, along with adding health equity measures to star ratings and boosting behavioral health network adequacy requirements. -
CMS proposes new rule for ACA plans: 5 things to know
CMS is proposing a new rule to streamline options on the ACA marketplace and add more provider network requirements. -
Bloomberg: It's time to end the public health emergency
The number of powerful voices calling for an end to the nation's COVID-19 public health emergency is growing larger.
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