CMS

The Medicare Advantage Marketing Problem and Where It’s Headed

by Victoria Bailey

Each year, Medicare’s open enrollment period starts mid-October and is preceded by an influx of marketing materials advertising private Medicare Advantage, Medicare Part D, and Medigap plans. While marketing practices are intended to...

How Do Rebates Impact Part D Spending for Plans, Beneficiaries?

by Victoria Bailey

While rebates may lower Medicare Part D spending for plan sponsors, they do not reduce drug costs for Medicare beneficiaries, a study conducted by the US Government Accountability Office (GAO)...

An Overview of the CMS AHEAD Model for Health Equity Advancement

by Kelsey Waddill

The CMS States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model) rallies states and a broad scope of healthcare stakeholders around health equity improvement through primary care investments and...

CMS: Ex Parte Systems May Disenroll Eligible Medicaid, CHIP Enrollees

by Kelsey Waddill

CMS has identified system errors that may unnecessarily disenroll eligible Medicaid and Children’s Health Insurance Program (CHIP) enrollees during the redetermination process and is calling on...

HHS Releases First 10 Drugs Eligible for Medicare Price Negotiation

by Victoria Bailey

Updated 10/3/2023: This article has been updated to include the drug companies' decisions to participate in the negotiation process. HHS has announced the first ten drugs that will be available...

74% of Terminated Medicaid Enrollees Were Cut for Procedural Reasons

by Kelsey Waddill

Millions of Medicaid enrollees have been disenrolled from Medicaid during the redetermination process, largely for procedural reasons, a KFF tracker noted. As of August 23, 2023, over 5.36 million...

How Can Medicare Advantage Organizations Prepare for RADV Audits?

by Victoria Bailey

Increasing internal audits and implementing additional coding oversight can benefit Medicare Advantage organizations as they manage new auditing regulations, Melissa James, senior consultant at Wolters Kluwer, told...

CMS Announces Monthly Payment Option for Out-of-Pocket Part D Costs

by Victoria Bailey

CMS has released draft guidance detailing a new program allowing Medicare beneficiaries to pay out-of-pocket Part D costs in monthly installments. The Medicare Prescription Payment Plan is required...

CQMC Revises Quality Measures, AHIP Advocates for Better Alignment

by Kelsey Waddill

Core Quality Measures Collaborative (CQMC) released new core quality measures and the implementation guidelines for certain core sets. More than 75 healthcare organizations, including payers,...

CMS Projects 2024 Medicare Part D Premiums Will Fall by 1.8%

by Victoria Bailey

Medicare Part D premiums are projected to decrease from $56.49 in 2023 to $55.50 in 2024, CMS announced. The projected average Part D premium represents the sum of the average basic premium and the...

Why CMS Paused Medicaid Coverage Redeterminations in 6 States

by Victoria Bailey

Almost four months after the Medicaid continuous enrollment provision ended, CMS has paused coverage redeterminations in at least six states. In a press call on July 19, CMS Administrator Chiquita...

CA, KY Expand Behavioral Health Services Through Mobile Crisis Teams

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) has approved proposals to expand behavioral health services for Medicaid beneficiaries in California and Kentucky through community-based mobile...

New York Extends Medicaid Postpartum Coverage to 12 Months After Birth

by Victoria Bailey

New York has extended Medicaid postpartum coverage, marking the 35th state that will provide comprehensive coverage to individuals for 12 months after pregnancy, HHS and CMS announced. “New...

Lawmakers Request More Info on Medicaid Redetermination Compliance

by Victoria Bailey

Lawmakers are calling on CMS and HHS to provide additional information on Medicaid redetermination standards following early reports of disenrollments due to administrative issues. In a letter to HHS...

Medicare Advantage Risk Adjustment Model Accuracy May Vary By Race

by Kelsey Waddill

The CMS-Hierarchical Condition Category (HCC) model used for Medicare Advantage risk adjustment may inaccurately estimate beneficiaries’ spending depending on the race or ethnicity of the...

Medicare Coverage of Alzheimer’s Drugs Relies on FDA Traditional Approval

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) has announced that it will provide Medicare coverage for new Alzheimer’s drugs if they receive traditional approval from the Food and Drug...

CMS Proposed Rule Addresses Drug Cost Transparency in Medicaid

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that aims to increase the transparency of prescription drug costs in Medicaid. “This proposed rule prioritizes...

Biden Admin Increases Access to School-Based Mental Health Services

by Victoria Bailey

The Biden-Harris Administration has announced three initiatives to increase access to school-based mental health services for children with Medicaid. “We are taking bold actions to strengthen...

CMS Proposes Transparency, Access Standards for Medicaid Managed Care

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) has released two proposed rules that would establish national access standards for Medicaid managed care plans and increase transparency of Medicaid...

CMS Approval Expands School-Based Health Services in Illinois

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) has approved a state plan amendment (SPA) in Illinois to expand school-based health services for children with Medicaid. The SPA will allow...