CMS

HHS Guidance Increases Care Access for Incarcerated Medicaid Beneficiaries

by Victoria Bailey

The US Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), has released guidance to help states boost access to healthcare for incarcerated...

HHS Finalizes Notice of Benefit and Payment Parameters for 2024

by Kelsey Waddill

The Department of Health and Human Services (HHS) has released the HHS Notice of Benefit and Payment Parameters for 2024 final rule which addressed network adequacy, plan selection, special enrollment...

Extended Medicare Advantage VBID Model Will Address SDOH, Health Equity

by Victoria Bailey

CMS has extended the Medicare Advantage value-based insurance design (VBID) model for an additional five years, with plans to implement changes that address beneficiaries’ social determinants of...

Medicare Advantage Final Rule Addresses Prior Authorization, Health Equity

by Victoria Bailey

CMS has finalized a Medicare Advantage rule that aims to increase marketing oversight, streamline prior authorization requirements, and improve access to affordable prescription drugs. “The...

HHS Finalizes 3.32% Increase in 2024 Medicare Advantage Payments

by Victoria Bailey

HHS has finalized the 2024 Medicare Advantage and Part D rate announcement, which includes a 3.32 percent increase in Medicare Advantage payments. “Medicare should be providing equitable,...

Stakeholder Groups Oppose Medicare Advantage Risk Adjustment Changes

by Victoria Bailey

Since CMS released the 2024 Medicare Advantage Advance Notice in February, healthcare stakeholders have not been silent about their concerns with the proposed risk adjustment model changes. CMS...

BMA Asks CMS to Rethink Medicare Advantage Risk Adjustment Model Changes

by Victoria Bailey

Better Medicare Alliance (BMA) has urged the Centers for Medicare and Medicaid Services (CMS) not to finalize its proposed changes to the Medicare Advantage risk adjustment model, stating that they...

What the Prior Authorization Proposed Rule Means for Payers

by Victoria Bailey

The CMS Advancing Interoperability and Improving Prior Authorization Processes proposed rule introduces new requirements for healthcare payers that aim to enhance patient data sharing and streamline...

AHIP Asks CMS to Reconsider Proposed Medicare Advantage Policy Changes

by Victoria Bailey

AHIP is urging CMS to consider the potential adverse impacts of its proposed rule for Medicare Advantage policy and technical changes, specifically raising concerns about the star rating changes, new...

HHS Introduces Models for Lowering Prescription Drug Spending

by Kelsey Waddill

The Department of Health and Human Services (HHS) has released three models intended to bring down prescription drug spending for consumers in Medicare and Medicaid. “These selected models will...

The Future of Medicare Advantage Risk Adjustment Data Validation

by Kelsey Waddill

Around four years passed between when CMS proposed the new rule on Medicare Advantage risk adjustment and when the Medicare Advantage Risk Adjustment Data Validation final rule was published. As stakeholders review the long-awaited final...

Overview of the 2024 Medicare Advantage Advance Notice, Payer Reactions

by Kelsey Waddill

CMS released the 2024 Medicare Advantage Advance Notice with changes for Medicare Advantage plans and Medicare Part D, stirring up concerns among some large payer organizations. “Medicare...

GAO: CMS Lacks Encounter Data for MA Supplemental Benefits

by Victoria Bailey

Nearly all Medicare Advantage plans offered supplemental benefits in 2022, but CMS received limited encounter data from the plans, a report from the Government Accountability Office (GAO) found. GAO...

HHS Approval Boosts Access to Care for Incarcerated Medicaid Beneficiaries

by Victoria Bailey

The US Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), has approved a section 1115 demonstration in California to help improve access to...

Proposed Rule Adds Contraceptive Coverage Pathway, Cuts Moral Exemption

by Kelsey Waddill

Under a newly proposed rule, the Biden administration would remove the moral exemption for health plan coverage of birth control while keeping the religious exemption intact, a fact sheet from the US...

HHS Finalizes Medicare Advantage Risk Adjustment Data Validation Program Rule

by Kelsey Waddill

The US Department of Health and Human Services (HHS) has released a final rule that aims to introduce more oversight into the Medicare Advantage risk adjustment data validation and payment...

CMS Announces ACA Special Enrollment Period during PHE Unwinding

by Kelsey Waddill

CMS announced that there will be a special enrollment period on the Affordable Care Act marketplace for individuals who lose their Medicaid coverage due to the public health emergency...

2023 Affordable Care Act Marketplace Enrollment Breaks Historic Records

by Kelsey Waddill

Affordable Care Act marketplace enrollment broke the previous all-time high by surpassing 16.3 million signups for the 2023 plan year, CMS and the Department of Health and Human Services (HHS)...

Most Impactful USPSTF Preventive Care Final Recommendations of 2022

by Kelsey Waddill

The US Preventive Services Task Force (USPSTF) released a list of its top preventive care recommendations that were finalized in 2022. The list is not comprehensive. Rather, USPSTF named the...

HHS Posts Timeline for Medicare 2026 Drug Price Negotiations

by Kelsey Waddill

In accordance with the Inflation Reduction Act, the US Department of Health and Human Services (HHS) announced that Medicare will begin drug price negotiations for prices going into effect in 2026 and...