CMS

PHE unwinding work may aid Medicaid, CHIP final rule compliance

April 11, 2024 - The eligibility and enrollment processes for Medicaid and the Children’s Health Insurance Program (CHIP) have been riddled with inefficiencies. Policies like annual coverage limits and waiting periods have created barriers for low-income adults and children seeking coverage through the public programs. The Biden administration aims to address these issues in the Streamlining the...

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Payers react to 2025 Medicare Advantage, Part D Final Rates

by Kelsey Waddill

Payer trade organizations responded negatively to the 2025 Medicare Advantage and Part D Final Rate Notice, citing rising healthcare costs. “The CMS Final Rate Notice failed to address the...

Medicare Advantage final rule addresses competition and marketing practices

by Victoria Bailey

CMS has finalized policies to promote competition in Medicare Advantage and Part D plans, boost access to behavioral healthcare services, and reduce deceptive marketing practices. The Contract Year...

CMS final rule improves access to Affordable Care Act marketplace coverage

by Victoria Bailey

CMS has finalized policies to increase access to marketplace coverage and expand essential health benefits (EHBs) in the HHS 2025 Notice of Benefit and Payment Parameters final rule. “Access to...

HHS extends special enrollment period for former Medicaid beneficiaries

by Victoria Bailey

HHS has extended the temporary special enrollment period to facilitate marketplace enrollment for beneficiaries who lost Medicaid or Children’s Health Insurance Program (CHIP) coverage following...

CMS chops short-term, limited duration plan length to 4 months

by Kelsey Waddill

The Biden administration has reduced the timeframe of short-term limited duration insurance plans, also known as “STLDI” or “junk” plans, in an effort to curb underinsurance,...

CMS final rule aims to simplify Medicaid, CHIP enrollment, coverage

by Kelsey Waddill

A new CMS final rule, the “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal...

MA Payment Reductions May Impact Value of Healthcare for Beneficiaries

by Victoria Bailey

The proposed 2025 Medicare Advantage Advance Notice would impact the value of healthcare for beneficiaries, resulting in higher costs, according to an analysis from the Berkeley Research Group...

Overcoming Tech Barriers to Achieve Prior Authorization Transparency

by Victoria Bailey

Prior authorization has posed problems for nearly all healthcare stakeholders. The CMS Interoperability and Prior Authorization Final Rule aims to streamline the utilization management process and improve data-sharing between payers,...

What Is Behind Rampant Medicare Advantage Contract Terminations?

by Victoria Bailey

With a history of overpayments, care denials, and limited provider networks, the relationship between Medicare Advantage and the rest of the healthcare industry has always been tumultuous. Over the past year, the private payer program has...

Lawmakers Lobby for Payment and Policy Stability in Medicare Advantage

by Victoria Bailey

A bipartisan group of United States Senators has urged CMS to ensure payment and policy stability in Medicare Advantage as the agency considers program updates for 2025. The letter to CMS...

CMS Proposes 3.7% Increase in Medicare Advantage Plan Payments

by Victoria Bailey

Medicare Advantage plan payments will increase by 3.7 percent or $16 billion in 2025, CMS proposed in the Calendar Year (CY) 2025 Advance Notice for the Medicare Advantage and Medicare Part D...

HHS Seeks Stakeholder Input to Improve Medicare Advantage Transparency

by Victoria Bailey

HHS has issued a request for information (RFI) to help improve data-sharing and transparency in the Medicare Advantage. Over half of all Medicare beneficiaries are enrolled in Medicare Advantage,...

CMS Finalizes Payer Requirements to Streamline Prior Authorization

by Victoria Bailey

CMS has finalized requirements for payers to streamline the prior authorization process and improve the electronic exchange of health information to help limit patient care disruptions. The CMS...

States Leverage Waivers To Support Medicaid Redetermination

by Kelsey Waddill

States flocked toward ex parte renewals and contact information update waivers to support Medicaid redetermination processes after the coronavirus public health emergency ended, a KFF brief found. For...

NY Medicaid Section 1115 Waiver Amendment Improves Access to Care

by Victoria Bailey

CMS has approved an amendment to New York State’s Medicaid section 1115 waiver that will address health disparities and improve access to primary and behavioral healthcare, Governor Kathy Hochul...

Elevance Health Lawsuit Slams Medicare Advantage Star Ratings Calculation

by Victoria Bailey

Elevance Health has filed a lawsuit against the Department of Health and Human Services (HHS), alleging its methodology for determining Medicare Advantage star ratings is unlawful. The payer and its...

Key Regulations and Policies That Will Impact Payers in 2024

by Victoria Bailey

As healthcare stakeholders and the federal government work to make healthcare more accessible and affordable for consumers, CMS and HHS are frequently introducing and finalizing new rules and regulations. There were a couple of key...

ACA Marketplace Enrollment Up By 33%, Surpassing 19M Enrollees

by Victoria Bailey

More than 19 million people have enrolled in Affordable Care Act (ACA) marketplace plans for 2024 coverage, HHS announced. This figure reflects enrollment data as of December 15, 2023, for states...

HHS Urges States to Reduce Medicaid, CHIP Child Disenrollments

by Victoria Bailey

The Department of Health and Human Services (HHS) is urging states to employ federal strategies to help reduce child disenrollments from Medicaid and the Children’s Health Insurance Program...

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