The Government Accountability Office (GAO) wants the Centers for Medicare and Medicaid Services (CMS) to increase oversight and enforcement of its hospital price transparency rules, according to a new report.
The 2021 CMS hospital price transparency rule requires hospitals to post prices in machine readable format and make those files...
Changes to the Medicare Advantage star ratings calculation are already having major impacts for insurers and their shareholders as Humana saw its stocks plunge after announcing that only a quarter of its members are enrolled in plans rated four stars or higher for 2025.
The Centers for Medicare and Medicaid Services (CMS) awards star...
This week, the Centers for Medicare and Medicaid Services released its report on the Acute Hospital Care at Home Initiative (AHCAH) and found that while the program was popular for both patients and providers, improvements in other areas were few.
The AHCAH initiative allowed certain Medicare-participating hospitals to treat patients...CMS Rules
The Centers for Medicare and Medicaid Services did not come to play this week when they filed 75,000 pages of records in response to a lawsuit brought against the nursing home staffing mandate.
This was the opening move by CMS since the American Health Care Association (AHCA) filed suit against the mandate earlier this year. According...
The Centers for Medicare and Medicaid Services (CMS) has finalized a landmark rule that will require insurers to provide parity between their coverage for mental health and medical or surgical benefits. The rule also aims to expand access to mental and behavioral health services.
The rule fulfills a proposal from last summer and will...
A recently published Milliman white paper discusses how the Inflation Reduction Act (IRA) will alter government funding for Medicare Part D in 2025, including increased Part D direct subsidies (DS) and benefit redesigns.
The 2025 average direct subsidy will increase to $142.67 per member per month, marking the highest level...
The Issue brief defines prior authorization and how this process used by Medicaid fee-for-service programs and managed care organizations (MCOs) requires approval before providing specific items, services, or medications.
Prior authorization (PA) aims to prevent unnecessary utilization, limit improper, fraudulent, and wasteful...
On Tuesday, the Biden administration released guidance on rules for the Medicare Prescription Payment Plan, a key aspect of the healthcare initiatives laid out in the Inflation Reduction Act of 2022 that aims to lower out-of-pocket costs for seniors with Medicare Part D prescription drug coverage.
The program is slated to launch in...Arizona News
This week in Medicaid a judge sides with the Centers for Medicare and Medicaid Services (CMS) against work requirements, the North Carolina Medicaid expansion remains on pace for over 600,000 additional members and the status of 1115 Waiver renewals nationwide.
The Georgia Pathways to Coverage program was the only one in the nation...
Earlier this year, two judges ruled that the Centers for Medicare and Medicaid Services (CMS) had improperly calculated Medicare Advantage scores and subsequent bonuses under the Star Ratings program last October. This week, CMS issued revised quality ratings for 2024, with a number of plans receiving far higher ratings and bonuses than...
Last week, a federal court in Texas issued a stay on a Centers for Medicare and Medicaid Services (CMS) final rule that would have increased oversight of agents and brokers contracting by Medicare Advantage plans. The stay will remain in effect for the duration of the lawsuit unless lifted by an appellate court.
The stay follows the...
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced last month that it would investigate the use of prior authorization in denials for post-acute care by Medicare Advantage plans.
In the new audit, OIG plans to look into processes for reviewing prior authorization requests for post-acute...
Last Friday, the Supreme Court of the United States (SCOTUS) issued a ruling that will radically curb the ability for the federal agencies to oversee entities as a regulator, which could have a major impact on federal healthcare authorities like the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) have decided to recalculate the 2024 Medicare Advantage (MA) star ratings and allow plans to resubmit bids for 2025 if their scores increase. Insurers are thrilled.
Two federal courts recently determined that CMS improperly calculated MA star ratings for 2024 after applying a...National News
National health spending continues to skyrocket and is expected to eclipse one fifth of the total U.S. economy by 2032, according to projections released last week by the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary.
The Office of the Actuary estimates that national health spending rose to $4.8 trillion in...
SCAN Health Plan won a massive case against the Centers for Medicare and Medicaid Services (CMS) this week when Judge Carl J. Nichols of the U.S. District Court for the District of Columbia ruled that the agency improperly calculated SCAN's star ratings scores which caused the company to lose out on millions in bonuses.
SCAN will be...
The Biden administration's nursing home minimum staffing rule could have a major impact on states' Medicaid programs, adding another layer of complexity to the highly anticipated and very controversial rule.
The nursing home minimum staffing rule is estimated to cost the residential care home industry up to $6.5 billion in additional...
The government is publicly reacting to the disruption in healthcare services caused by the Change Healthcare cyberattack and subsequent extended outage, but tangible consequences for UnitedHealth Group have yet to emerge.
The House Energy and Commerce Committee met this week to discuss the attack, but according to Modern Healthcare,...
The Biden administration brought down the hammer on Medicare Advantage insurers and their brokers when the Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Advantage Part D final rule last Thursday.
The rule increases regulatory scrutiny on prior authorization, network adequacy standards and marketing for...
The Centers for Medicare and Medicaid Services released the proposed rule for 2025 hospice reimbursement including a 2.6% raise in per diems and two new quality measures.
The 2.6% net increase would amount to a $705 million increase from FY 2024, including a 3% market basket update and a 0.4% cut for productivity. According to the...
