In the first part of its Advance Notice for calendar year 2022, CMS has proposed completely phasing in the CMS-Hierarchical Condition Categories (HCC) for Medicare Advantage risk adjustment, finalizing...
Concerns over provisions of the Medicaid Fiscal Accountability Rule (MFAR) have compelled CMS to rescind the rule proposed last November.
In a tweet late Monday, CMS Administrator Seema Verma...
CMS has confirmed that Georgia’s Section 1332 state innovation waiver, which changes the Affordable Care Act exchange model, is complete. The waiver will now move into a public comment...
As the coronavirus pandemic continues to rage across the US, the payer industry must consider how the current environment will affect Medicare Advantage Star Ratings for years to come. The industry may...
Although the interoperability rule will not be implemented until mid-2021, payers can be aware of what to expect regarding how this rule will change their processes, as outlined in a recent AHIP...
New York has announced 2021 premium rates and the state appears to be following CMS’s lead for 2020 rates by keeping 2021 rates low.
The New York State Department of Financial Services announced...
Around one-fifth of Americans continue to rely on consumer assistance to navigate their healthcare coverage options, but not all of them can access the help that they need, a Kaiser Family Foundation...
Medicare Advantage plans and other stakeholders reported that CMS waivers successfully enabled Medicare and Medicare Advantage telehealth access during the coronavirus pandemic, but several barriers...
The Centers for Medicare and Medicaid Services (CMS) announced that it will allow payers to use premium credits to temporarily lower the individual and small group exchange premiums for...
The average basic premium for Medicare Part D prescription plans will be the second lowest average Part D premium since 2013, CMS announced.
“The Trump Administration has prioritized policies...
The blow to employer-sponsored plans in the final three quarters of 2020 could be lower than anticipated largely because coronavirus impacts have concentrated on lower income populations, Robert Wood...
Medicare Advantage plans may see higher healthcare spending on end-stage renal disease (ESRD) populations when the new Medicare Advantage and Part D rule goes into effect, an Avalere study...
CMS has proposed a rule that allows payers to adopt new value-based payment models for gene therapies.
“CMS’s rules for ensuring that Medicaid receives the lowest price available for...
Due to the coronavirus, telehealth utilization is soaring. Some payers have seen their telehealth utilization increase by 50 times their typical levels within a couple of months.
Payers and providers...
Audio-only diagnoses should be factored into Medicare Advantage risk adjustment, Better Medicare Alliance (BMA) stated in a letter to CMS which HealthPayerIntelligence received by email.
“We...
More than 1,750 Medicare Advantage and Medicare Part D plans will participate in the Part D Senior Savings Model in order to offer lower insulin costs in 2021, CMS announced.
“President Trump...
CMS has finalized changes to Medicare Advantage and Medicare Part D telehealth policies and supplemental chronic disease management benefits. The agency has also expanded Medicare Advantage for rural...
CMS has released the final 2021 payment notice along with news that it will extend the qualified health plan timeline by one week to account for coronavirus uncertainties in premium rate...
Better Medicare Alliance has followed up on its recommendations to CMS and HHS that take into account the uncertainties Medicare Advantage health plans currently face in making bid submissions for...
Waivers to Medicaid and the Children’s Health Insurance Program (CHIP) give state programs flexibility to better respond to COVID-19.
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