Bright Health Group has been ordered to liquidate by a Texas court, which will block the enforcement of risk-adjusted transfer payments in Texas that the company has defaulted on.
According to Fierce Healthcare, Bright agreed to a repayment agreement with the Centers for Medicare and Medicaid Services (CMS) for $89.6 million, or...CMS Rules
This week, federal regulators issued an interim final rule that would take action against states that have not complied with the federal Medicaid eligibility rules or reporting requirements during the redetermination period.
The rule says that the Centers for Medicare and Medicaid Services (CMS) will require noncompliant states to...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule rule, which includes a 3.34% decrease to the schedule's conversion factor, setting it at $32.74, a $1.15 decrease from 2023.
The agency finalized other increases for visits including primary and longitudinal care, and...
The Centers for Medicare and Medicaid Services (CMS) released the CY2024 Outpatient and Ambulatory Surgical Center Prospective Payment System (OPPS), which included an increase for outpatient hospitals and ASCs of 3.1%.
The final rule's raise was larger than the 2.8% initially proposed, which the agency attributed to industry response...
Arizona Health Care Cost Containment System (AHCCCS) is investing $47.5 million from ARP Awards to help strengthen HCBS in Arizona.
Starting on December 4, 2023, eligible HCBS providers can apply for up to $1 million for programmatic or infrastructure projects to improve HCBS for round 2 of the ARP Program Awards. All applications...
On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would impose tighter regulations on Medicare Advantage insurers. The rule covers some hotly debated issues including prior authorization, supplemental benefits and marketing.
President Joe Biden announced last year that his administration would...
Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the CY2024 Home Health Prospective Payment System (HH PPS) Rule, which included cuts that cancelled out market basket raises to the industry.
The pay cut is a result of the Patient-Driven Groupings Model (PDGM), which ties reimbursements to patient...
The Centers for Medicare and Medicaid Services (CMS) has offered its suggestion for a solution to the Supreme Court decision that would return $9 billion to hospitals that were paid less than rates the court said were set unconstitutionally.
Last year, the U.S. Supreme Court (SCOTUS) ruled unanimously that the differential payment...
Last week, the Biden administration announced a proposed rule through the U.S. Department of Health and Human Services (HHS), Labor and the Treasury Department that would implement the independent dispute resolution process (IDR process) outlined by the No Surprises Act, which seeks to protect patients and medical services consumers from...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) released the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule for CY2024 and it includes high expected costs for the Medicare program, but renal disease advocacy groups are accusing the agency of underpaying standalone clinics and introducing a pay...National News
Last week, the Senate Finance Committee held a hearing on the topic of "cracking down on deceptive practices" related to the advertisement of Medicare Advantage (MA) plans.
The hearing covered a long list of issues with third-party marketers who represent MA plans, including allegations of false information, harassment, switching...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) announced this week that it would expand coverage for PET scans used in the diagnosis of Alzheimer's disease.
CMS has been hesitant to open reimbursements for the procedure, and the agency has long said that it would only cover one brain scan per beneficiary for a patient's...Arizona News
Arizona's Medicaid program announced this week that it hit the mid-point of the renewal process and boasted one million retentions to the program. During the quarterly Arizona State Medicaid Advisory Committee (SMAC) meeting this week, AHCCCS reported since April 2023, those losing Medicaid coverage in the state total 320,000 with...Arizona News
Roughly halfway through the Medicaid eligibility review, states are now leaning on waivers from the federal government to lower disenrollment rates due to procedural reasons. Also, the Centers for Medicare and Medicaid Services (CMS) intervened to prevent half a million children from disenrollment by raising states' awareness of a system...CMS Rules
Low-income Medicare beneficiaries are expected to see some much needed relief as a result of a new rule issued by the Centers for Medicare and Medicaid Services (CMS) this week. The rule seeks to simplify the enrollment and renewal processes for Medicare Savings Programs (MSPs), as many beneficiaries are currently encumbered from...CMS Rules
Physicians and related stakeholder groups have rallied against the 2024 physician fee schedule proposed rule, which was issued in July. The rule is expected to be finalized shortly, but providers are saying that any cuts could jeopardize access to primary care.
The proposed rule contains a 3.36% cut to the conversion factor for...
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) published the proposed rule for nursing home federal staffing minimums and guidelines. The proposed rule was rebuffed by the nursing home industry and related stakeholders, as the nursing home workforce is already depleted due to the pandemic exacerbating an already...
Under the Inflation Reduction Act (IRA) people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation.
The IRA, signed by President Biden in 2022, applied to Part D the same year, whereas Part B took effect in 2023. The Centers for Medicare & Medicaid...
As public and political pressure has risen against prior authorization, insurers are scaling back use of the policy and are openly reforming the process.
Back in February, the American Medical Association (AMA) led 118 other medical organizations to write a letter to the Centers for Medicare and Medicaid Services, specifically...
Humana has filed suit against the Centers for Medicare and Medicaid Services (CMS) for a rule announced earlier this year that would allow the government to recoup overpayments from insurers based on extrapolated audits. Also, Novartis has challenged the Biden administration over the Medicare Drug Price Negotiation rule.
Studies have...