Policy / Regulatory Changes
Signals classified into this topic vertical.
235 signals
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Medicaid Work Reporting Requirements: States Ask a Federal Court to Protect Medically Frail Individuals from CMS Overreach
On June 3, CMS issued an Interim Final Rule (IFR) misinterpreting the work reporting requirements enacted last July in H.R. 1. The H.R. 1 provisions were bad enough, but as my colleague Leo Cuello has explained, the IFR imposes policies on states and individuals that the Congress did not enact. Most notably, the IFR makes […]
Policy / Regulatory Changes · 67 signals · last 30 days -
Decoding Medicare Advantage Coding Intensity
Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS, the effects on beneficiaries, and other proposals to improve payment accuracy.
Policy / Regulatory Changes · 67 signals · last 30 days -
Nearly Four Million Medicare Beneficiaries Met the Eligibility Criteria in 2023 for the Medicare GLP-1 Bridge
Medicare has launched a temporary program covering GLP-1s for obesity for people with Medicare, known as the Medicare GLP-1 Bridge. This analysis estimates the number of Medicare Part D enrollees who could potentially qualify for the Bridge program by meeting all of the eligibility criteria, based on claims data from 2023.
Policy / Regulatory Changes · 67 signals · last 30 days -
Request for Information (RFI): Pharmacy Benefit Manager Compensation and Data Collection
This request for information (RFI) solicits technical input on the services and business practices of pharmacy benefit managers ("PBMs") and their affiliates to inform implementation of recent legislation. It specifically focuses on gathering information to inform two specific legislative requirements that are effective beginning calendar year 2028: restrictions on the remuneration that PBMs and their affiliates may receive for services in connection with the utilization of covered Part D dru...
Policy / Regulatory Changes · 67 signals · last 30 days -
Cavagnuolo v. Becerra
insurance benefits, and Part C—also known as Medicare Advantage—acts as a coverage alternative that uses Original document
Policy / Regulatory Changes · 67 signals · last 30 days -
Better Medicare Alliance Statement on HHS-OIG Prior Authorization Report
WASHINGTON —Better Medicare Alliance (BMA) issued the following statement today from Mary Beth Donahue, President and CEO of Better Medicare Alliance, on the HHS Office of Inspector General report on … Continue reading "Better Medicare Alliance Statement on HHS-OIG Prior Authorization Report" The post Better Medicare Alliance Statement on HHS-OIG Prior Authorization Report appeared first on Better Medicare Alliance .
Policy / Regulatory Changes · 67 signals · last 30 days -
Medicare Part D Enrollment, Premiums, and Cost Sharing in 2026
The Medicare Part D program provides an outpatient prescription drug benefit to 56 million older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analyzes Medicare Part D enrollment, premiums, and cost sharing in 2026 and trends over time, based on data from the Centers for Medicare & Medicaid Services (CMS).
Policy / Regulatory Changes · 67 signals · last 30 days -
How Medicare Advantage Rebates Disadvantage Medicare’s Stand-Alone Drug Plan Market
The private plans that offer the Medicare Part D benefit - stand-alone drug plans and Medicare Advantage drug plans - are increasingly are competing on uneven terms, in part because the payment system for Medicare Advantage plans enables them to lower Part D premiums or reduce Part D cost sharing, making drug coverage from Medicare Advantage plans appear considerably cheaper, or even premium-free, to the beneficiary. This brief discusses the growing instability of the Part D stand-alone drug...
Policy / Regulatory Changes · 67 signals · last 30 days -
United States ex rel. Osinek v. Kaiser Permanente et al.
Medicare Advantage risk adjustment coding litigation. This case has been consolidated with five other lawsuits filed by former employees against Kaiser Permanente. The other five cases are: United States ex rel. Stein et al. v. Kaiser Foundation Health Plan, Inc. et al. (3:16-cv-05337); United States ex rel. Arefi et al. v. Kaiser Foundation Health Plan, Inc. et al. (3:16-cv-01558); United States […] The post United States ex rel. Osinek v. Kaiser Permanente et al. appeared first on Health Ca...
KaiserKaiser Permanente · 5 signals · last 30 days -
What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge
This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE Model, and potential impacts on beneficiaries and program budgets.
Policy / Regulatory Changes · 67 signals · last 30 days -
Medicaid Waste, Fraud, and Abuse: Why CMS’s Improper Payment Rate Can’t Be Trusted
The post Medicaid Waste, Fraud, and Abuse: Why CMS’s Improper Payment Rate Can’t Be Trusted appeared first on Paragon Health Institute .
Policy / Regulatory Changes · 67 signals · last 30 days -
In Medicaid fraud crackdown, feds now looking to audit all 50 states
Dr. Mehmet Oz, the administrator of the federal Centers for Medicare & Medicaid Services, said Tuesday that the Trump administration will require every state within 30 days to turn in a plan to revalidate the health care providers that participate in their Medicaid programs. The Trump administration has pledged to root out what it calls […]
Policy / Regulatory Changes · 67 signals · last 30 days -
United States et al. ex rel. Mazik v. Kaiser Foundation Health Plan Inc. et al.
Medicare Advantage risk adjustment coding litigation. The post United States et al. ex rel. Mazik v. Kaiser Foundation Health Plan Inc. et al. appeared first on Health Care Litigation Tracker .
KaiserKaiser Permanente · 5 signals · last 30 days -
Better Medicare Alliance Statement on CY2027 Medicare Advantage and Part D Final Rate Announcement
WASHINGTON — Better Medicare Alliance (BMA) issued the following statement today from Mary Beth Donahue, President and CEO of Better Medicare Alliance, on the 2027 Medicare Advantage and Part D … Continue reading "Better Medicare Alliance Statement on CY2027 Medicare Advantage and Part D Final Rate Announcement" The post Better Medicare Alliance Statement on CY2027 Medicare Advantage and Part D Final Rate Announcement appeared first on Better Medicare Alliance .
Policy / Regulatory Changes · 67 signals · last 30 days -
United States v. Anthem Inc.
Medicare Advantage risk adjustment coding litigation. The post United States v. Anthem Inc. appeared first on Health Care Litigation Tracker .
AnthemElevance Health · 11 signals · last 30 days -
United States ex rel. Cutler v. Cigna Corporation et al.
Medicare Advantage risk adjustment coding litigation. The post United States ex rel. Cutler v. Cigna Corporation et al. appeared first on Health Care Litigation Tracker .
CignaCigna · 10 signals · last 30 days -
United States ex rel. Zafirov v. Florida Medical Associates, LLC et al.
Medicare Advantage risk adjustment coding litigation. The post United States ex rel. Zafirov v. Florida Medical Associates, LLC et al. appeared first on Health Care Litigation Tracker .
Policy / Regulatory Changes · 67 signals · last 30 days -
United States ex rel. Ormsby v. Sutter Health et al.
Medicare Advantage risk adjustment coding litigation. The post United States ex rel. Ormsby v. Sutter Health et al. appeared first on Health Care Litigation Tracker .
Policy / Regulatory Changes · 67 signals · last 30 days -
Re: CMS Request for Information (RFI) Related to Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) RIN 0938-AV97
The post Re: CMS Request for Information (RFI) Related to Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) RIN 0938-AV97 appeared first on Paragon Health Institute .
Policy / Regulatory Changes · 67 signals · last 30 days -
PUBLIC COMMENT: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health (CMS-9883-P)
The post PUBLIC COMMENT: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health (CMS-9883-P) appeared first on Paragon Health Institute .
Policy / Regulatory Changes · 67 signals · last 30 days -
New Video Ads: Kathy’s Story Highlights the Stakes in Medicare Advantage Funding Fight
WASHINGTON — When Sturgeon Bay, Wisconsin, retiree Kathy Bandstra broke her hip on the same day she met CMS Administrator Dr. Mehmet Oz, she faced an $81,000 medical bill. Not … Continue reading "New Video Ads: Kathy’s Story Highlights the Stakes in Medicare Advantage Funding Fight" The post New Video Ads: Kathy’s Story Highlights the Stakes in Medicare Advantage Funding Fight appeared first on Better Medicare Alliance .
Policy / Regulatory Changes · 67 signals · last 30 days -
More Than 100 Organizations Urge CMS to Ensure Stability for Medicare Advantage Beneficiaries in Final Rate Notice
WASHINGTON — A coalition of 110 organizations representing physicians, nurses, health systems, community-based organizations, employer groups, supplemental benefit partners, and beneficiary advocates is urging the Centers for Medicare & Medicaid … Continue reading "More Than 100 Organizations Urge CMS to Ensure Stability for Medicare Advantage Beneficiaries in Final Rate Notice" The post More Than 100 Organizations Urge CMS to Ensure Stability for Medicare Advantage Beneficiaries in Final Rat...
Policy / Regulatory Changes · 67 signals · last 30 days -
Beyond Minnesota: Four Medicaid Services Vulnerable to Fraud and the Case for Stronger CMS Enforcement
The post Beyond Minnesota: Four Medicaid Services Vulnerable to Fraud and the Case for Stronger CMS Enforcement appeared first on Paragon Health Institute .
Policy / Regulatory Changes · 67 signals · last 30 days -
Advancing Choice, Competition, and Fiscal Sustainability in Medicare: A Roadmap for CMS
The post Advancing Choice, Competition, and Fiscal Sustainability in Medicare: A Roadmap for CMS appeared first on Paragon Health Institute .
Policy / Regulatory Changes · 67 signals · last 30 days -
Blue Cross and Blue Shield of Florida, Inc. et al. v. Department of Health and Human Services et al.
Medicare Advantage Star Ratings litigation. The post Blue Cross and Blue Shield of Florida, Inc. et al. v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .
Blue Cross Blue Shield plans · 20 signals · last 30 days