Marc Ryan

Medicare Advantage and Part D Star Changes From 2026 Proposed CMS Rule

New measures and major Star changes coming The just released 2026 Medicare Advantage and Part D rule from the Centers for Medicare and Medicaid Services (CMS) has a number of important Star program measure and policy updates. As promised, here is my thorough assessment of the Star changes from the rule. See Monday’s blog here for the rest of the proposals in the rule: https://www.healthcarelabyrinth.com/large-ma-and-part-d-rule-issued-for-2026/ . Will the changes really go into effect? What will happen to these proposals is anyone’s guess right now. The Biden administration did not publish the rule in time to finalize it before the current president leaves office. That will allow the incoming Trump administration the ability to delay final publication and remove significant portions if it wants to. I don’t expect the new administration to disturb some of the technical changes and customary roll out of Star measures, but it likley will stop some

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December 4, 2024

Tragedy In New York A tragedy in New York today as UnitedHealthcare CEO Brian Thompson, the leader of UnitedHealth Group’s insurance subsidiary, was shot and killed just before an investor meeting in Manhattan. All indications point to the fact that the shooting was premediated and targeted and not a random act. Our thoughts and prayers are with Thompson’s family and the UnitedHealth community. Additional articles: https://www.modernhealthcare.com/people/unitedhealthcare-ceo-brian-thompson-shot-new-york-city and https://www.healthcaredive.com/news/unitedhealthcare-ceo-brian-thompson-fatally-shot-nyc/734557/ (Some articles may require a subscription.) #unitedhealthcare https://www.fiercehealthcare.com/payers/reports-unitedhealthcare-ceo-brian-thompson-fatally-shot-manhattan Progress On Stop Gap Measure To Fund Government Republican lawmakers have proposed a lame-duck healthcare deal to Democrats that includes extending key Medicare telehealth measures and the Acute Hospital Care at Home program for three years as well as a one-year Medicare physician pay patch. This would be paid for with a full repeal of the Biden administration’s nursing home staffing rule and pharmacy benefit manager reforms. (Article may require a subscription.) #crs #governmentshutdown

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December 3, 2024

Government Spending Bill Needed In Next Two Weeks With the government running out of money as of December 20, Congress is back for a lame-duck session and needs to pass a permanent funding bill or stop-gap continuing resolution (CR) soon. The latest guess is that the parties will come together in each chamber to pass a stop-gap CR and boot major funding and policy decisions until the next Congress. But that certainly puts Democrats at a disadvantage as they become the minority in both chambers. But the sheer work to get a permanent bill passed is likely just too much right now for anyone. There is wide speculation on what will happen with various healthcare policy proposals. Many hope for a great deal of healthcare bills to be rolled up into an end-of-year act. But that hope is dying given all that needs to be done. More likely are some

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December 2, 2024

United And Centene Get Star Hikes For 2025 After a federal court ordered the Centers for Medicare and Medicaid Services (CMS) to revise United Healthcare’s 2025 Star ratings, the agency issued new Star ratings for both United and Centene today. The agency increased the quality ratings for 12 UnitedHealthcare contracts and 7 Centene contracts. Centene now has a sole 4-Star contract under the agency changes. Two United contracts were upgraded to 5 Stars and three contracts to 4 stars. United now will have 37 contracts rated at least 4 stars. The United and Centene cases surrounded how CMS handled the two call center ratings. Centene sued like United and the Centene case is still pending. It likely will be withdrawn. Humana and Elevance Health also sued and both suits are still pending. No changes to Star ratings have yet been made for Humana and Elevance Health.  One reason could be

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Large MA And Part D Rule Issued For 2026

2026 Medicare Advantage and Part D rule has major changes to the programs The Biden administration issued its draft 2026 Medicare Advantage (MA) and Part D rule last week. A draft is available, but the Federal Register indicates the rule was pulled back for additional clarifications and would be reposted on December 10. Due to its late posting, the rule will not be finalized before the Trump administration takes office and therefore could simply be revamped rather than be rescinded. In some ways, the rule does not have some of the mega changes that some expected in the areas of Star, risk adjustment, and more. This could be due to some sensitivity to the current financial woes of the MA industry. But there is plenty for the industry to object to. I have read the 700-plus page draft rule and reviewed the Centers for Medicare and Medicaid Services (CMS) Fact

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Constitutional Checks And Balances Working

The Gaetz withdrawal shows the Constitution is being taken seriously Another quick deviation from healthcare in the interest of democracy this Thanksgiving weekend. On November 18, my blog covered the issue of recess appointments. I said that the Senate has to fulfill its constitutional functions and resist the concept of recess appointments as recommended by President-elect Donald Trump. Days after taking office, President-elect Trump urged the Senate to allow him to make such recess appointments to get his cabinet and other key officials in place quickly. I argued that this would amount to an abrogation of the Senate’s duty to vet and approve key officials. Yes, recess appointments are mentioned in the Constitution, but the provision was included for good reason in bygone days when Congress was not in session year-round. It helped ensure government could function properly by giving the president some latitude to appoint officials when Congress was

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51. Why Trump And The GOP Should Safeguard The ACA

There are many reasons Trump and the GOP should safeguard the Affordable Care Act, including the fact it saves and is key to overall healthcare reform. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform

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November 27, 2024

Paragon Says DOGE Could Save $2.1 Trillion In Healthcare Donald Trump has created the informal Department of Government Efficiency (DOGE) to reduce the size of government. He is also looking for budget cuts to help pay for extension of his 2017 tax cuts. As such, healthcare spending cuts are anticipated. Trump is chummy with certain conservative healthcare policy groups, including the Paragon Health Institute. Paragon has put together some possible healthcare cuts amounting to $2.1 trillion in savings over a decade. The possible reductions include the following. While Trump has said he will preserve Medicare, some Medicare cuts are below. The proposals are not a radical reform of current healthcare programs, but would remove a great deal of funding, shift costs to states and citizens, and mean reduced coverage overall. Some proposals, such as site neutral payments and certain Medicaid and Medicare abusive hospital funding practices, are tremendous ideas. As

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November 26, 2024

New MA And Part D Rule Issued As Parting Policy Shot By Biden Administration The Biden administration issued its draft 2026 Medicare Advantage (MA) and Part D rule today. A draft is available, but the Federal Register indicates the rule was pulled back for additional clarifications and would be reposted on December 10. Due to its late posting, the rule would not be finalized before the Trump administration takes office and therefore could simply be revamped rather than be rescinded. In some ways, the rule does not have some of the mega changes that some expected in the areas of Star, risk adjustment, and more. This could be due to some sensitivity to the current financial woes of the MA industry. But there is plenty for the industry to object to. I have not done a thorough read yet of the 700-plus page draft rule, but I will do so

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November 25, 2024

Media Attacking Trump Healthcare Picks As Contrarians The mainstream media are busy attacking Donald Trump’s healthcare picks as public health and healthcare contrarians. They worry the administration could aim to set vaccine policy that is outside of the so-called mainstream. So far, Trump has named the following to lead key agencies: The media are less concerned about Oz and Makary and most concerned with Kennedy and Weldon. Some of the criticism is unfair, especially toward Makary. During the COVID years, Makary stood out as a man of science and great educator, calling out the need for COVID vaccines for those most vulnerable to the virus but reasonably pushing back on COVID vaccine hysteria and other excesses. Additional article: https://www.managedhealthcareexecutive.com/view/trump-names-picks-for-top-jobs-at-fda-and-cdc-and-also-surgeon-general  (Article may require a subscription.) #healthcare #trump #election2024 #hhs #cms #fda https://www.modernhealthcare.com/politics-policy/donald-trump-health-nominees-vaccines-fda-marty-makary-cdc-dave-weldon Hospital Price Transparency Dropping Not Increasing New findings by Patient Rights Advocate finds that just 21.1% of hospitals are

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