Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule for Medicare Advantage (MA) that increases the agency's efforts to provide oversight to participating plans.
The rule includes new reasons for denying contracts or expanding contracts based on past performance. Modern Healthcare...
Last Thursday, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report that strongly suggests that Medicare Advantage (MA) plans delayed or denied medical treatments and procedures to beneficiaries that met the Medicare coverage requirements.
Analysts with the Office of the Inspector...
On Monday, the Centers for Medicare and Medicaid Services (CMS) published the final 2023 Medicare Advantage (MA) Part D rate announcement, which includes an 8.5% rate increase for MA and Part D plans. The agency will not adjust the MA star rating system but will be soliciting solutions to the system that incorporates a path to the Biden...
The success of Medicare Advantage (MA) can't be understated. In the last 11 years, the program has grown to represent nearly 50% of the Medicare-eligible market, a benchmark it will likely pass within the next year.
Arizona MA growth reflects the program's national success. At the Hertel Report's 2020 Winter State of the State, Dan...
Following approval by the Food and Drug Administration (FDA) last year, the Centers for Medicare and Medicaid (CMS) proposed last month to cover the Alzheimer’s disease drug Aduhelm only for beneficiaries enrolled in a clinical trial. The proposal has sparked fierce debate among insurance groups, drugmakers, policymakers and the...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
Last Friday, the House of Representatives passed the Build Back Better Act, the massive social and climate spending bill that carries the promises of the Biden presidential platform. After several months of negotiations between democrats and revisions in the plan for how the bill would get passed, the bill is considerably smaller and...National News
The pandemic put a damper on merger and acquisition (M&A) activity among hospitals. Now, looking forward, the question is whether such activity is a lifeline for a reeling industry or a greedy practice bad for everyday patients.
The consulting firm Ernst & Young’s (EY) Global Capital Barometer found global M&A...National News
This week, the Centers for Medicare and Medicaid Services (CMS) is learning from prior models and plans to make adjustments within Medicare Advantage for dual eligibles and hospice care. In other MA news, Anthem and UnitedHealthcare were penalized for failing to meet the medical loss ratio (MLR) threshold of 85%.
CMS is moving forward...Arizona News
Spending per beneficiary is growing faster in Medicare Advantage (MA) and private plans than traditional Medicare and Part D prescription drug plans, according to the MedPAC analysis.
Modern Healthcare reports that the spending disparity has experts concerned, considering that Medicare Advantage enrollment is surging, currently...National News
Analysis released by insurance lobbyist America's Health Insurance Plans (AHIP) shows that adding vision, dental and hearing benefits to traditional Medicare will increase premiums and plans for Medicare Advantage plans unless adjustments to Medicare Advantage payments are included.
Congress is currently considering adding the...
The special enrollment period for individual health care plans offered through the Affordable Care Act has been a boon for major health insurers participating in the Marketplace. But many insurers are concerned that extending the SEP could cause unintended issues for insurers and enrollees alike. Also, the Brookings Institute says that...
A new bill introduced by Representatives Suzan DelBene (D-Wash.), Peter Welch (D-Vt.), Darin LaHood (R-Ill.) and Brad Wenstrup (R-Ohio) looks to reverese Trump-era modifications to the Medicare Accountable Care Organization (ACO) program and restore higher cost savings to participating providers while removing some of the risk. The bill...National News
COVID-19 is on the upswing again due to the Delta variant's dominance nationwide. But skilled nursing facilities' vaccination rates among staff and healthcare professionals has plateaued. Organizations are taking action to encourage stronger vaccination policies. Additionally, insurance companies are now calling foul on CARES Act...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services (CMS) approved a final rule requiring payers to build application program interfaces to support data exchange and streamline prior authorization. Medicaid and the Children’s Health Insurance Program (CHIP); healthcare exchange plans are also required to comply with the...Arizona News
Last Friday, the Centers for Medicare and Medicaid Services (VMS) released Part II of the 2022 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and D Payment Policies. The first part was released in September and both will be finalized by April 5.
CMS expects Part D payments to rise...National News
A new bill from Congressional Democrats seeks to increase subsidies for the Consolidated Omnibus Budget Reconciliation Act (COBRA) and ostensibly provide relief to workers who have lost their jobs and potentially their health insurance during the COVID-19 pandemic.
The bill, called the Worker Health Coverage Protection Act, is...Arizona News
Last week the Centers for Medicare and Medicaid Services with the Department of Labor and the Treasury Department released guidelines for health insurers to cover diagnostic testing for COVID-19.
This news comes on the heels of a request from America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield for relief for...National News
Last week, the health insurance marketplace for the state of California released an actuarial brief projecting that testing and treatment COVID-19 costs for the national commercial medical market could range from $34 billion to $251 billion; projections also include premium increases to individuals and employers ranging from 4% to...National News
Officials in the Trump administration are weighing the possibility of opening a special enrollment period to expand coverage to uninsured persons during the COVID-19 pandemic.
The unemployment rate has spiked due to the coronavirus, leaving anywhere between 500,000 and 5 million people suddenly without insurance. Arizona currently has...
