The Office of the Inspector General (OIG) found that most of the audited diagnosis codes that Geisinger Health Plan sent to CMS for its Medicare Advantage plan were non-compliant.
The office audited...
While insurance coverage rates improved for Black, Hispanic, and White adults during the first two years of the COVID-19 pandemic, the gains were more significant in states that had implemented...
States are responding to the public health emergency unwinding in a variety of ways, with some states placing greater emphasis on continuity of coverage than others, a Kaiser Family Foundation (KFF)...
Medicaid waivers that focus on individuals with autism spectrum disorder (ASD) can help reduce disenrollment rates among autistic adolescents, a study published in JAMA Network Open found.
Autistic...
As Medicare Advantage enrollment grows, the Medicare Payment Advisory Commission (MedPAC) is calling on Congress to address payment and coding differences between Medicare Advantage and Medicare...
Medicaid coverage of behavioral health services in 2022 varied across states, but the majority of state Medicaid programs reported covering at least half of all services, according to an issue brief...
Beneficiaries with end-stage renal disease (ESRD) are increasingly shifting from Medicare fee-for-service (FFS) to Medicare Advantage, leading more Medicare Advantage plans to form value-based...
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...
The Department of Health and Human Services (HHS) and CMS have lowered prices for over two dozen Medicare prescription drugs including biologics for a set timeframe.
Starting on April 1, 2023,...
In most states, beneficiaries who lose Medicaid coverage when the public health emergency ends are likely to transition into employer-sponsored health plans, according to a study funded by AHIP from...
AHIP has introduced a new outlet for healthcare industry collaboration around the Medicaid redetermination process: the Connecting to Coverage Coalition (CCC).
The payer organization and its partners...
Medicaid managed care organizations can leverage financial bonds to help increase funds for social determinants of health interventions and avoid underinvesting, according to research published in...
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...
With Medicaid continuous enrollment coming to an end on March 31, 2023, states are expected to see a decline in Medicaid enrollment after three years of growth, a Kaiser Family Foundation (KFF)...
Medicare Advantage beneficiaries with ambulatory care sensitive conditions (ACSCs) experienced lower rates of hospitalizations but higher rates of emergency department (ED) direct discharges and...
Since Montana’s Medicaid expansion policy went into effect in 2016, the program has seen strong results in its preventive care services utilization efforts and Medicaid spending, according to a...
Medicare Part D plan liability could lead to major changes in benefits and formulary design for beneficiaries in the coming years, according to an Avalere study that was funded by PhRMA.
The...
Medicare Advantage beneficiaries were more likely to enroll in hospice from a community setting rather than a hospital or nursing home setting compared to traditional Medicare beneficiaries, according...
AHIP is pushing back on the proposed 2024 Medicare Advantage advance notice because it presents a dramatic rate cut that would impact beneficiaries, Matt Eyles, president and chief executive officer of...
Updated 2/17/2023: This article has been updated to reflect a correction to the original data. The previous version of this article said that 26 percent of ACA plans had deductibles between $4,501...
