Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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1.1 million Medicare beneficiaries signed up for GLP-1 Bridge model
Roughly 1.1 million Medicare beneficiaries have signed up to access discounted GLP-1s through CMS’ Bridge model, HHS Chief Counselor Chris Klomp said during an Oct. 7 Wall Street Journal event. The pilot launched July 1, rolling out to Medicare Part D beneficiaries who meet specific clinical criteria. The pilot intends to reach beneficiaries needing anti-obesity […] The post 1.1 million Medicare beneficiaries signed up for GLP-1 Bridge model appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al. (Alignment II)
Medicare Advantage Star Ratings litigation. The post Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al. (Alignment II) appeared first on Health Care Litigation Tracker .
Alignment HealthcareAlignment Healthcare · 3 signals · last 30 days -
Alignment Healthcare sues CMS over its 2027 Medicare Advantage star ratings
Alignment Healthcare sued federal regulators, alleging that its 2027 Medicare Advantage star ratings were determined "in flagrant violation" of statute.
Alignment HealthcareAlignment Healthcare · 3 signals · last 30 days -
Payers face a choice on price transparency: Comply or adopt
CMS shared its Transparency in Coverage rulemaking — formed in partnership with the Labor and Treasury departments — on Oct. 5. Now, payers are reckoning with the changes. The rule updated previous regulations introduced by the Trump administration in 2020, such as a requirement for payers to post negotiated rates. The recent rule cuts so-called […] The post Payers face a choice on price transparency: Comply or adopt appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
ACHP Recommendations for an Inferred Risk Adjustment Model
ACHP urges CMS to preserve separate payment terms for state directed payments and coordinate with NAIC so risk-based capital reflects the risk plans bear. Source
Policy / Regulatory Changes · 140 signals · last 30 days -
From policy to practice: How health plans can operationalize CMS payment integrity changes
CMS is reshaping how health plans approach payment integrity. Faster regulatory cycles along with heightened scrutiny of improper payments have resulted in expanded audits for providers and payers. This represents a greater emphasis on prevention and real-time intervention as increasing pressure on payers to ensure medical claims are reimbursed accurately. Today’s challenge goes far beyond […] The post From policy to practice: How health plans can operationalize CMS payment integrity changes...
Policy / Regulatory Changes · 140 signals · last 30 days -
Humana rebounds, Aetna slips: Winners and losers in the 2027 MA star ratings
Federal regulators released the hotly anticipated star ratings for the 2027 Medicare Advantage plan year, and winners and losers emerged in the data.
HumanaAetnaHumana + CVS Health / Aetna · 24 signals · last 30 days -
Fierce Healthcare Regulatory Recap: CMS releases 2027 MA star ratings; HHS awards $28M for falls prevention
The latest news from CMS, HHS and more across Washington, D.C.
Policy / Regulatory Changes · 140 signals · last 30 days -
‘Somebody cares about this enough’: What the ICHRA-to-CHOICE rebrand means
In September, CMS rebranded individual coverage health reimbursement arrangements as CHOICE arrangements, short for Custom Health Option and Individual Care Expense. The ICHRA benefits model first launched in 2020. Through the model, employers give workers fixed, tax-free contributions to buy individual health insurance. The CHOICE rebrand has been a long time coming. The CHOICE name […] The post ‘Somebody cares about this enough’: What the ICHRA-to-CHOICE rebrand means appeared first on Beck...
Policy / Regulatory Changes · 140 signals · last 30 days -
ACHP Members Lead 2027 Star Ratings and NCQA Ratings
ACHP member plans averaged 4.23 Stars in 2027 Medicare Advantage Star Ratings, vs. 3.96 for other plans, and earned 13 of 18 five-star NCQA ratings. Source
Policy / Regulatory Changes · 140 signals · last 30 days -
STAT+: Medicare Advantage star ratings trigger new bonuses, and uncertainty
The federal government has released new quality ratings for Medicare Advantage insurers for 2027, with Humana emerging as the biggest winner. But deep uncertainty remains around Medicare Advantage quality measures,…
HumanaHumana · 13 signals · last 30 days -
Humana’s star ratings turnaround: 5 notes
Humana has pulled off a Medicare Advantage star ratings turnaround, with 95% of the insurer’s members in plans rated four stars or higher for 2027, compared to 20% a year ago. “I’m grateful for what our team accomplished this year, and we’re already looking at what’s next and pushing ourselves to do even more for […] The post Humana’s star ratings turnaround: 5 notes appeared first on Becker's Payer Issues | Payer News .
HumanaHumana · 13 signals · last 30 days -
Better Medicare Alliance Responds to 2027 Medicare Advantage Star Ratings Announcement
WASHINGTON — Better Medicare Alliance (BMA) today released the following statement in response to the Centers for Medicare & Medicaid Services’ (CMS) release of the 2027 Medicare Advantage Star Ratings … Continue reading "Better Medicare Alliance Responds to 2027 Medicare Advantage Star Ratings Announcement" The post Better Medicare Alliance Responds to 2027 Medicare Advantage Star Ratings Announcement appeared first on Better Medicare Alliance .
Policy / Regulatory Changes · 140 signals · last 30 days -
How can I compare my Medicare coverage options?
You can compare your Medicare coverage options using an online searchable tool on the Medicare.gov website that allows users to compare Medicare coverage options, including Medicare Advantage plans, Medicare Part D plans, and Medigap supplemental policies.
Policy / Regulatory Changes · 140 signals · last 30 days -
I have a Medigap policy now, but I want to buy a different one. Can I switch Medigap policies during the Medicare Open Enrollment period?
The annual Medicare Open Enrollment period is designed for enrolling in or switching Medicare Advantage and Part D prescription drug plans, not Medigap policies.
Policy / Regulatory Changes · 140 signals · last 30 days -
I’m receiving extra help with my Part D plan premium and cost sharing through the Low-income Subsidy Program. I received a notice that my current plan will no longer be offered next year. Now what do I do?
If you qualify for extra help with your Medicare prescription drug costs, are enrolled in traditional Medicare, and your current prescription drug plan will not be offered next year, you will be automatically reassigned by Medicare to a new prescription drug plan for coverage in the next year.
Policy / Regulatory Changes · 140 signals · last 30 days -
I’m having a hard time affording my Medicare Part D drug coverage. Are there any options for me?
You may want to find out if you qualify for extra assistance with your Part D plan premiums and cost sharing, if your income and assets are low enough.
Policy / Regulatory Changes · 140 signals · last 30 days -
Humana soars, Alignment plummets in 2027 Medicare Advantage star ratings
A Healthcare Dive analysis of highly anticipated stars data shows a mixed bag of winners and losers, though — as expected — the quality scores slipped overall. See how major carriers fared for 2027.
HumanaHumana · 13 signals · last 30 days -
CMS: About 71% of MAPD plan enrollees in coverage with four or more stars for 2027
The Trump administration has released the 2027 Medicare Advantage star ratings, with many enrollees in plans that earned at least four stars.
Policy / Regulatory Changes · 140 signals · last 30 days -
2027 Medicare Advantage and Part D Star Ratings
2027 Medicare Advantage and Part D Star Ratings Note: The information included in this Fact Sheet is based on the 2027 Medicare Advantage (MA) and Part D Star Ratings published on the Medicare Plan Finder on Oct. 8, 2026. For details on the methodology of the MA and Part D Star Ratings, please refer to the 2027 Part C & D Star Ratings Technical Notes available at http://go.cms.gov/partcanddstarratings .
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Advantage plans with 5 stars in 2027
Fifteen Medicare Advantage plans earned five-star ratings for 2027, down from 22 last year. CMS released the ratings Oct. 8. Of the 508 contracts that were rated, 188 (37%) earned four stars or higher, compared with about 44% in 2026. The enrollment-weighted average MA star rating was 3.99 this year, compared with 4.01 in 2026, […] The post Medicare Advantage plans with 5 stars in 2027 appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
77% of Medicaid improper payments tied to paperwork, not fraud: Report
CMS estimates that 77% of fiscal year 2025 Medicaid improper payments resulted from insufficient documentation rather than fraud or abuse, according to an Oct. 7 report from the Congressional Research Service. The report outlines how federal and state agencies oversee Medicaid program integrity. CRS is a nonpartisan agency within the Library of Congress that prepares […] The post 77% of Medicaid improper payments tied to paperwork, not fraud: Report appeared first on Becker's Payer Issues | P...
Policy / Regulatory Changes · 140 signals · last 30 days -
ACHP Urges CMS to Align State Directed Payment Policy With Plans’ Financial Risk
ACHP urges CMS to preserve separate payment terms for state directed payments and coordinate with NAIC so risk-based capital reflects the risk plans bear. Source
Policy / Regulatory Changes · 140 signals · last 30 days -
Florida court orders expungement of grand jury report on $10M Centene donation
A Florida appellate court ruled Oct. 7 to expunge a grand jury report regarding a $10 million Centene donation to the Hope Florida Foundation, tied to Florida’s first lady, Casey DeSantis. Florida prosecutors launched a criminal investigation into the donation, which was part of a broader $67 million settlement in 2024 to resolve allegations of […] The post Florida court orders expungement of grand jury report on $10M Centene donation appeared first on Becker's Payer Issues | Payer News .
Centene FloridaCentene · 13 signals · last 30 days -
Strengthening Medicare Advantage in 2028: ACHP Recommendations to CMS
ACHP urges CMS to simplify risk adjustment, modernize network adequacy and refine Star Ratings in 2028 to protect Medicare Advantage beneficiary choice. Source
Policy / Regulatory Changes · 140 signals · last 30 days