CMS projects that Medicare Advantage and Part D premiums are an estimated 14 percentage points lower than 2019 premiums, dropping from $26.87 to approximately $23.00 this 2020 open enrollment...
CMS efforts to empower Medicare Advantage plans to tackle social determinants of health (SDOH) led mainly to the expansion of existing benefits but not the addition of new benefits, stakeholders told...
Tennessee is the first state to seek a block grant waiver for its Medicaid program.
“The traditional model of Medicaid financing is an outdated model of fundamentally misaligned...
American Hospital Association (AHA) is concerned that the recent CMS proposal to relax the 2015 mandatory Medicaid access monitoring review plans will limit providers’ ability to confront...
The health insurance tax, mandated in the Affordable Care Act, will be back in effect in 2020 and is set to generate $15.5 billion in taxes due to CMS’s new 2020 payment rule.
“This new...
Among publicly insured patients with the potentially chronic condition hepatocellular carcinoma (HCC), 35 percent had a longer wait time for a liver transplant, possibly indicating poor care...
CMS approved the second part of Alaska’s Section 1115 Medicaid demonstration waiver addressing behavioral healthcare. The first part, addressing substance abuse care, was approved in November...
With its newly consolidated company, Cigna and Express Scripts are diving into the costly field of gene therapy and intend to increase members’ access through their new program, Embarc Benefit...
A CMS rule expands its ability to revoke or deny providers’ position serving in federal networks in an effort to combat fraud in Medicare, Medicaid, and CHIP.
“The provisions we are...
Private payers and public payers alike have been working to assist states thrashed by Hurricane Dorian by driving care coordination and patient care access.
After HHS Secretary Alex Azar declared a...
America’s Health Insurance Plans (AHIP) discouraged CMS from finalizing the risk adjustment data validation (RADV) changes suggested in the agency’s Notice of Proposed Rulemaking (NPRM)...
The Office of Inspector General (OIG) audited Medicare spending and found that CMS spent $160.8 million paying for drugs that should have been covered by hospices. This data follows a 2012 OIG report...
CMS released a new Medicare Plan Finder that helps beneficiaries compare Medicare Advantage and Part D plans.
“The redesigned Medicare Plan Finder is another example of how CMS is empowering...
CMS released a letter detailing the agency’s strategy for determining a sponsored immigrant’s eligibility for public benefits such as Medicaid and CHIP coverage. The letter came in response...
California-based Health2047’s new health plan, Zing Health, will offer a Medicare Advantage plan that aims to address social determinants of health, the company announced.
"Zing Health is...
CMS finalized a decision to provide Medicare coverage for chimeric antigen receptor (CAR) T-cell therapy, which is an FDA-approved gene therapy used to treat non-Hodgkin lymphoma and B-cell precursor...
Payer organizations are voicing their opposition to CMS’s Medicare Outpatient Prospective Payment System (OPPS) rule, stating that publishing negotiations would prevent payers from obtaining...
A Humana study comparing the differences in medication therapy management (MTM) services found that targeted medication reviews (TMR) were highly successful interventions.
“This study highlights...
HHS and the US Department of the Treasury approved Colorado’s Section 1332 waiver to develop a reinsurance program, CMS announced.
The waiver will exempt Colorado from Section 1332 of the...
CMS Administrator Seema Verma declared Medicare Advantage the most successful result of Medicare and criticized the program’s other functions.
Verma also offered harsh words about proposals for...
