Four United States Senators have called on CMS to improve data collection and reporting in the Medicare Advantage program to help regulators understand how plan design impacts care quality, cost, and...
CMS has proposed provisions to improve protections for Medicare Advantage beneficiaries, prevent anti-competitive practices, and strengthen access to behavioral healthcare services.
The Contract Year...
Cigna’s recent brush with False Claims Act violations serves as a reminder that Medicare Advantage organizations should be routinely assessing their risk and compliance activities.
The Department of Justice (DOJ) announced in...
Monthly Medicare Part B premiums will increase by nearly $10 in 2024 due to a projected increase in healthcare spending, CMS announced.
Medicare Part B covers physician services, outpatient hospital...
CMS is reminding state health officials of the upcoming continuous coverage requirements for children in Medicaid and the Children’s Health Insurance Program (CHIP).
Provisions in the...
Ahead of the Medicare Open Enrollment Period, CMS has announced that Medicare Advantage premiums, benefits, and plan choices will remain relatively stable in 2024.
“A top priority for CMS...
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...
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)...
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 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...
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...
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...
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 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...
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,...
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...
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...
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 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 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...
