The CMS-Hierarchical Condition Category (HCC) model used for Medicare Advantage risk adjustment may inaccurately estimate beneficiaries’ spending depending on the race or ethnicity of the...
The Centers for Medicare and Medicaid Services (CMS) has announced that it will provide Medicare coverage for new Alzheimer’s drugs if they receive traditional approval from the Food and Drug...
The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that aims to increase the transparency of prescription drug costs in Medicaid.
“This proposed rule prioritizes...
The Biden-Harris Administration has announced three initiatives to increase access to school-based mental health services for children with Medicaid.
“We are taking bold actions to strengthen...
The Centers for Medicare and Medicaid Services (CMS) has released two proposed rules that would establish national access standards for Medicaid managed care plans and increase transparency of Medicaid...
The Centers for Medicare and Medicaid Services (CMS) has approved a state plan amendment (SPA) in Illinois to expand school-based health services for children with Medicaid.
The SPA will allow...
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...
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...
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...
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 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,...
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...
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...
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 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...
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...
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...
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...
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...
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...
