Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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ACHP Statement on Introduction of the MA STARS Act
ACHP applauds Rep. Mike Kelly's MA STARS Act, which centers Medicare Advantage Star Ratings on clinical quality, patient outcomes and patient experience. Source
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS finalizes model that aims to bring most-favored nation pricing to Part B
The Trump administration has finalized a new model that aims to bring its most-favored nation pricing approach to Medicare Part B.
Policy / Regulatory Changes · 140 signals · last 30 days -
STAT+: Trump’s watered-down Medicare drug pricing rule saves 96% less than initial proposal
WASHINGTON — The Trump administration published a final rule aimed at lowering Medicare prices for drugs administered in doctor offices. It applies to only four companies. The Global Benchmark for…
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
Policy / Regulatory Changes · 140 signals · last 30 days -
11 payers exiting Medicare Advantage in 2027
Eleven payers are exiting the individual Medicare Advantage market for 2027, according to CMS data. Seven of the eleven are owned entirely or in part by health systems. Several other payers will stay in MA next year only through special needs plans, including Molina Healthcare, Horizon BCBS New Jersey, New York City-based MJHS Health System’s […] The post 11 payers exiting Medicare Advantage in 2027 appeared first on Becker's Payer Issues | Payer News .
Molina Healthcare + Blue Cross Blue Shield plans · 37 signals · last 30 days -
4 new Medicare Advantage insurers in 2027
There will be four new entrants to the Medicare Advantage market in 2027, according to CMS data. In contrast, 11 payers that sold individual MA plans in 2026 won’t offer them next year, and the largest insurers collectively are pulling out of hundreds of counties nationwide. Here are the four new MA insurers for 2027, […] The post 4 new Medicare Advantage insurers in 2027 appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS finalizes new drug pricing model: 7 notes
CMS has finalized the Global Benchmark for Efficient Drug Pricing (GLOBE) Model, a mandatory payment model that will tie Medicare Part B drug rebates to prices paid in 19 reference countries, according to a Sept. 30 CMS news release. Here are seven things to know: The post CMS finalizes new drug pricing model: 7 notes appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Advantage insurers expanding, shrinking SNP footprints in 2027
While some payers are slimming down their Medicare Advantage reach, some are betting big on special needs plans. SNPs cover dually eligible Medicaid individuals (D-SNP), those with chronic conditions (C-SNP) and those needing long-term care (I-SNP). CMS released data Sept. 28 breaking down the 2027 MA landscape overall. The agency expects a slight dip in […] The post Medicare Advantage insurers expanding, shrinking SNP footprints in 2027 appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
‘You need to look into it’: Dr. Oz pitches CHOICE health plans to small businesses
CMS Administrator Mehmet Oz, MD, is urging employers to consider an alternative to traditional group health plans that allows workers to select their own individual insurance coverage. Speaking Sept. 30 at an event in Austin, Texas, Dr. Oz promoted CHOICE Arrangements, the new federal branding for individual coverage health reimbursement arrangements, as an option for […] The post ‘You need to look into it’: Dr. Oz pitches CHOICE health plans to small businesses appeared first on Becker's Pay...
Policy / Regulatory Changes · 140 signals · last 30 days -
Judge narrows California pension fund lawsuit against UnitedHealth
A federal judge has thrown out most of a securities fraud lawsuit brought by the country’s largest pension fund against UnitedHealth Group, but will let claims that the company misled investors about previous asset sales move forward. The California Public Employees’ Retirement System (CalPERS) originally sued in May 2024, alleging UnitedHealth, former CEO Andrew Witty […] The post Judge narrows California pension fund lawsuit against UnitedHealth appeared first on Becker's Payer Issues | Pay...
UnitedHealth CaliforniaUnitedHealthcare · 46 signals · last 30 days -
Medicare Advantage insurers ranked by county entries, exits in 2027
Many major health insurers are pulling back from some counties in 2027, while Singh Holdings, Blue Cross of Idaho and Devoted Health boosted their footprint. CMS released data Sept. 28 on the 2027 Medicare Advantage landscape, showing which counties insurers are serving or exiting next year. MA plan options are decreasing next year in 29 […] The post Medicare Advantage insurers ranked by county entries, exits in 2027 appeared first on Becker's Payer Issues | Payer News .
Devoted Health + Blue Cross Blue Shield plans · 37 signals · last 30 days -
Fraud in Federal Programs: Limited Beneficial Ownership Information Available on Awardees
What GAO Found Illicit actors hide their beneficial ownership in multiple ways to fraudulently access federal awards, such as contracts, grants, and Medicare payments, and to evade payment on taxes. GAO’s review of federal cases highlights tactics illicit actors have used, such as using stolen identities, shell companies, professional enablers, and pass-through billing schemes to hide ownership. For example, from July 2019 through January 2023, three purported hospice owners stole identities...
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements; Correction
This document corrects technical errors in the final rule that appeared in the August 3, 2026 Federal Register titled "Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements".
Policy / Regulatory Changes · 140 signals · last 30 days -
15 payers with Medicare Advantage enrollment caps for 2027
CMS released initial insights on the 2027 Medicare Advantage landscape Sept. 28, along with data breaking down plans. One wrinkle gaining attention: enrollment capacity limits. In April, CMS said insurers could include enrollment caps for specific plans in their 2027 MA bids, relying on existing regulatory authority. With these caps, plans cannot disenroll current members. […] The post 15 payers with Medicare Advantage enrollment caps for 2027 appeared first on Becker's Payer Issues | Payer N...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS to expand IRF claim review demonstration to all facilities billing the jurisdiction that includes Alabama, Georgia, Tennessee
The Centers for Medicare & Medicaid Services announced Sept. 25 that it will expand the Inpatient Rehabilitation Facility Review Choice Demonstration to include all IRFs that bill Medicare Administrative Contractor Jurisdiction J, which generally includes Alabama, Georgia and Tennessee. The demonstration, which is currently active for IRFs in Alabama, California, Texas and Pennsylvania, subjects 100% of all Original Medicare IRF claims to either pre-claim or post-payment review. For IRFs newl...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS projects decline in MA, small increase in standalone Part D premiums for 2027
The Centers for Medicare & Medicaid Services announced Sept. 28 that it projects declines in average premiums for Medicare Advantage and Part D in 2027. Weighted average MA premiums are expected to decline 16.5% from $14.37 in 2026 to $12.00 in 2027. The total average monthly Part D premium for standalone prescription drug plans is estimated to increase by less than $1, from $35.09 in 2026 to $36 in 2027. Following application of MA rebates, average Part D premiums for MA plans with prescript...
Policy / Regulatory Changes · 140 signals · last 30 days -
Better Medicare Alliance Responds to CMS 2027 Medicare Advantage Premiums and Plan Landscape
WASHINGTON — Better Medicare Alliance (BMA), the nation’s leading research and advocacy organization supporting Medicare Advantage, today issued the following statement in response to the Centers for Medicare & Medicaid … Continue reading "Better Medicare Alliance Responds to CMS 2027 Medicare Advantage Premiums and Plan Landscape" The post Better Medicare Alliance Responds to CMS 2027 Medicare Advantage Premiums and Plan Landscape appeared first on Better Medicare Alliance .
Policy / Regulatory Changes · 140 signals · last 30 days -
UnitedHealthcare received $24M in Medicare Advantage overpayments in Texas: OIG
UnitedHealthcare’s Medicare Advantage business in Texas received an estimated $24.4 million in overpayments during 2020 and 2021 tied to diagnoses not supported by medical records, the HHS Office of Inspector General said in an audit report published Sept. 28. The report follows an OIG audit released a week prior that estimated UnitedHealthcare’s Wisconsin MA business […] The post UnitedHealthcare received $24M in Medicare Advantage overpayments in Texas: OIG appeared first on Becker's Payer...
UnitedHealthcare · 46 signals · last 30 days -
Here’s how much insurers are cutting Medicare Advantage plans for 2027
Newly released CMS data gives the market its first comprehensive look at how insurers are adapting to continued pressure in the privatized Medicare program. A press release stressing “stability” didn’t soften the blow.
Policy / Regulatory Changes · 140 signals · last 30 days -
Agency Information Collection Activities: Proposed Collection; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Int...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS projects lower Medicare Advantage premiums in 2027
Plans are expecting Medicare Advantage enrollment of 34 million beneficiaries in 2027, or about 47.4% of all Medicare enrollees, according to a Sept. 28 CMS news release. This would be flat compared with the 2026 projection, but actual MA enrollment was 36.1 million as of June. CMS released early insights and projections just ahead of […] The post CMS projects lower Medicare Advantage premiums in 2027 appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
UnitedHealthcare, TeamHealth settle $100M alleged upcoding case
UnitedHealthcare and TeamHealth have settled a lawsuit in which the insurer accused the physician staffing company of upcoding emergency department claims. The lawsuit was voluntarily dismissed with prejudice Sept. 24 in Tennessee federal court, according to court records. The dismissal comes after the payer and hospital staffing company told the court Aug. 11 they had […] The post UnitedHealthcare, TeamHealth settle $100M alleged upcoding case appeared first on Becker's Payer Issues | Payer...
UnitedHealthcare TennesseeUnitedHealthcare · 46 signals · last 30 days -
The states losing the most Medicare Advantage plans in 2027
Medicare Advantage plan choice will fall in more than half of states in 2027, even as CMS projects lower average premiums and a nearly unchanged number of available plans nationwide. The decline follows widespread disruption in 2026, when as many as 2.9 million MA enrollees had to find new coverage after their plans were discontinued […] The post The states losing the most Medicare Advantage plans in 2027 appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
UnitedHealthcare, Team Health settle $100M fraud suit in Tennessee
A 2021 legal battle between UnitedHealthcare and Team Health was dismissed after the parties reached a settlement, per court documents.
UnitedHealthcare TennesseeUnitedHealthcare · 46 signals · last 30 days -
Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027
Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027 The Centers for Medicare & Medicaid Services (CMS) today announced significant premium savings for millions of Medicare beneficiaries in 2027, with weighted average MA premiums projected to fall more than 16% from 2026 to 2027, and average prescription drug premiums in Medicare Advantage projected to plummet 38%.
Policy / Regulatory Changes · 140 signals · last 30 days