CMS

CMS Supports Modernizing Enrollment on State-Based Exchanges

by Kelsey Waddill

CMS is offering $20 million in grants to states in order to update their state-based exchanges in light of the spike in Affordable Care Act marketplace enrollment. “Our State-based Marketplaces...

Experts Consider Impacts of SCOTUS Affordable Care Act Decision

by Kelsey Waddill

Since the Supreme Court dismissed California v Texas on June 17, payers and healthcare leaders have vocalized their support for the decision, their readiness to continue building on the Affordable Care...

4 Payers That Have Embraced Value-Based Care Models in 2021

by Kelsey Waddill

Updated 6/11/2021: This article has been updated with a quote from Blue Cross and Blue Shield of Minnesota's chief medical officer. A previous version included an quote from a partner of Blue...

CMS Raises Awareness of ACA Marketplace Coverage for Gig Workers

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) is asking online platform companies to bring awareness to their gig workers’ ability to obtain Affordable Care Act marketplace coverage during...

ARP Boosted Funding for Home, Community-Based Services, SDOH

by Kelsey Waddill

The American Rescue Plan boosted the federal matching rate (FMAP) for Medicaid home and community-based services (HCBS), thereby increasing federal spending on social determinants of health, according...

Endpoint Directory Supports Payer Interoperability Compliance

by Kelsey Waddill

CAQH has officially launched the CAQH Endpoint Directory to support payers with interoperability compliance as they prepare for approaching deadlines in 2021 and 2022. “The need for the endpoint...

How Payers Can Improve Attachment Processes in Claims Management

by Kelsey Waddill

Claims management is a multi-step process that provides ample opportunity for errors and delays, but if payers modify their approach to certain steps in the process it could have a positive impact...

Humana Joins Traditional Medicare Value-Based Contracting Model

by Kelsey Waddill

Humana has announced that it will be participating in a CMS traditional Medicare value-based contracting model and will offer coordinated care for traditional Medicare...

CMS Finalizes Second 2022 Payment Notice with Cost-Sharing Limits

by Kelsey Waddill

The second 2022 Notice of Benefit and Payment Parameters final rule (“2022 payment notice”) finalized changes that made cost-sharing limits $400 lower than what CMS had proposed in...

AHIP Protests Medicare Coverage of Innovative Technology Rule

by Kelsey Waddill

As CMS reconsiders the Medicare Coverage of Innovative Technology (MCIT) rule which was finalized in mid-January 2021, America’s Health Insurance Plans (AHIP) has expressed its concerns regarding...

CMS Approves IL Waiver to Support Rural, Black Maternal Health

by Kelsey Waddill

In order to support rural and Black maternal healthcare, HHS has offered states the option to extend maternal Medicaid coverage and Illinois is the first state to receive approval for the amendment,...

5 States With Highest SEP Enrollment Rejected Medicaid Expansion

by Kelsey Waddill

CMS has released special enrollment period enrollment levels data, which has seen more than 500,000 new enrollees and will last another four months. “Access to quality, affordable health care is...

HHS Will Spend $50M on Outreach for Special Enrollment Period

by Kelsey Waddill

The US Department of Health and Human Services (HHS) and CMS announced that the Biden Administration would spend $50 million to advertise the special enrollment period. “We’re...

How Payers Can Prepare for the Payer Price Transparency Rule

by Kelsey Waddill

Payers should prepare for the payer price transparency rule to go into effect by building clear communication paths with members, reassessing their contracting processes, and asking themselves a couple...

New CMS Guidance Could Increase COVID-19 Testing Rates, Spending

by Kelsey Waddill

Since the Biden administration has eliminated the ability to deny coronavirus testing claims due to “medical necessity,” payers should expect higher coronavirus testing rates across all...

How Medicaid Work Requirements Could Impact Low-Income Women

by Kelsey Waddill

As policymakers decide the fate of Medicaid work requirements, the impacts of these policies are becoming more clear, particularly their effects on low-income women, a Kaiser Family Foundation (KFF)...

OBGYNs Face Challenges When Providing Care To Medicaid Members

by Hannah Nelson

Obstetrician-gynecologists (OBGYNs) experience reimbursement and referral challenges for care provided to Medicaid beneficiaries, according to a new nationally representative survey of OBGYNs conducted...

CMS Puts $2.3M Toward Navigator Funding for Special Enrollment

by Kelsey Waddill

CMS will be offering $2.3 million in additional navigator funding for grantees in light of the special enrollment period, the agency announced by email. “President Biden has made clear that...

CMS Moves to Rescind Medicaid Work Requirements As Anticipated

by Kelsey Waddill

The Biden administration has reversed CMS policy on Medicaid work requirements, according to letters the agency sent to multiple Medicaid programs. In a letter to Wisconsin’s Medicaid director...