CMS
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CMS: MA Premiums To Remain the Same for Most Beneficiaries in 2024
The average monthly plan premium for Medicare Advantage is expected to increase only slightly in 2024 from 2023, CMS said. About 73% of beneficiaries will see no increase at all.
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HHS: Medicaid/CHIP Coverage To Be Reinstated for 500K People
Thirty states have been conducting Medicaid and CHIP automatic renewals incorrectly, leading to many individuals being wrongly removed from coverage. Because of this, nearly 500,000 children and other individuals will have their coverage reinstated.
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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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CMS Is Getting More Serious About Penalizing Hospitals For Price Transparency Noncompliance
CMS has fined two hospitals in September for alleged violations of its price transparency rule. This marks the third month in a row that the agency has issued fines against hospitals for price transparency noncompliance, following a yearslong period of light enforcement.
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Meaningful Hospital Price Transparency Requires Actual Prices, Not Estimates
Only actual hospital prices, displayed as dollars and cents, not estimates, formulas, or algorithms, protect patients from outrageous bills and hold hospitals accountable for overcharges, errors, and fraud. Accepting CMS’ or other substitutes instead of actual prices undermines broader efforts to make hospital price transparency a reality for American patients and healthcare consumers.
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Nursing Homes Reject CMS’ Proposed Staffing Level Requirements
CMS released a proposed rule to establish staffing standards among the nation’s nursing homes. Reactions have been mixed — but mainly negative. Long-term care facilities say that they can neither find nor afford more workers. On the other hand, some lawmakers argue the proposed rule doesn’t do enough to protect care quality for patients. As for labor unions, they seem generally happy with the rule.
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CMS Requires States To Assess Medicaid Disenrollment Process
Some states may not be following federal requirements for the Medicaid renewal process, resulting in many individuals being wrongly removed from coverage, CMS said. Children may especially be affected.
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CMS: Medicare Shared Savings Program Saved Medicare $1.8B in 2022
For the sixth year in a row, the Medicare Shared Savings Program created overall savings, CMS announced. When compared to clinician groups of a similar size not participating in the program, participating ACOs performed better on quality measures, including measures for diabetes, breast cancer and colorectal cancer screenings, tobacco screenings and depression screenings.
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Who is Supporting Family Caregivers?
The role of the family caregiver is considered part of the cycle of life. But it can be time consuming and stressful, especially if caregivers have to balance their role with a job, raising children, and other aspects of family life. The topic will be one of many discussed at the HLTH event in Las Vegas from October 8-11.
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CMS Lowers No Surprises Act Fee After Court Nixes Price Hike
CMS recently announced that it will change the administrative fee that providers and insurers must pay when initiating a reimbursement dispute under the No Surprises Act — the agency is lowering the fee from $350 to $50. This move came a week after the Texas Medical Association won a court case challenging HHS over its 600% price hike on the fee.
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Applying Remote Patient Monitoring to Surgery Prep and Recovery, Oncology and Women’s Health
Join us to learn about the latest trends in remote monitoring and how to extend its benefits beyond chronic conditions to more patients – all while using fewer staff resources.
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CMS Anticipates a 1.8% Decrease in Medicare Part D Monthly Premiums for 2024
The average total monthly premium for Medicare Part D coverage is expected to be $55.50 in 2024, down from $56.49 in 2023, according to CMS.
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Hospitals’ Price Transparency Compliance Is Improving Despite Remaining Low at 36%
About 36% of U.S. hospitals are in compliance with CMS’ price transparency rule, up from 24.5% in February, according to a new report. This progress will remain slow unless CMS can do a better job of effectively enforcing its rule, the report declared.
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Report: 10 Prescription Drugs Took Up 22% of Medicare Part D Spending in 2021
KFF found that the 10 top-selling Part D drugs represented $47.7 billion of the $215.7 billion total gross Medicare Part D drug spending in 2021. Eliquis, a blood thinner by Bristol Myers Squibb, accounted for the most spending out of these 10 drugs at $12.6 billion.
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‘This Is Almost Biblical in Its Impact’: Providers Push Back Against CMS’ New Proposed Rules
CMS recently revealed its proposals to raise reimbursement rates for hospital outpatient departments and cut payments for physicians. Next year, the agency is planning to decrease physicians’ pay by 1.25% and increase outpatient payment rates by 2.8%. Provider groups are unhappy with the news — AMA President Dr. Jesse Ehrenfeld said the new physician fee schedule will be “almost biblical in its impact.”
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BioPharma, Hospitals, Legal, Payers, Policy
Hospitals Have Concerns About CMS’ Proposed $9B Lump Sum Payment for Illegal 340B Cuts
CMS recently proposed a $9 billion lump sum payment to remedy illegal payment cuts for 340B drugs from 2018 to 2022. In general, hospital groups have reacted positively to the fact that 340B providers will receive lump sum payments but have expressed concern about CMS’ methods for maintaining budget neutrality with this plan.
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CMS Tests New Primary Care Model in 8 States
The Making Care Primary Model will be tested by the Center for Medicare and Medicaid Innovation from July 1, 2024, to December 31, 2034, in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington.
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Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
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Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.
