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June 11, 2024

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More Information On Elevance Health Star Lawsuit Win

Yesterday we told you about Elevance Health’s win in court on the 2024 Star calculations.  Other healthcare publications have written stories today.  The pressure is on the Centers for Medicare and Medicaid Services (CMS) to respond.  I have also linked the lawsuit below.

Additional articles: https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms and https://www.beckerspayer.com/payer/elevance-health-gets-partial-victory-in-star-ratings-lawsuit.html#:~:text=The%20judge%20ruled%20partially%20in,only%20for%20BCBS%20of%20Georgia.  and https://www.healthcaredive.com/news/elevance-wins-medicare-advantage-star-ratings-lawsuit-hhs/718550

Opinion: https://www.documentcloud.org/documents/24740919-elevance_becerra_6724_order

(Some articles may require a subscription.)

#medicareadvantage #stars #cms

https://www.fiercehealthcare.com/payers/elevance-health-earns-partial-win-legal-fight-over-ma-star-ratings

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June 10, 2024

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Elevance Wins Star Lawsuit

A second lawsuit has been decided in favor of a Medicare Advantage (MA) plan and against the Centers for Medicare and Medicaid Services (CMS) on the calculation of Star scores. In this case, Elevance Health won its suit and a judge declared that Georgia contract scores must be revised. It will be increasingly difficult for CMS to ignore these rulings. I will write on this on LinkedIn tomorrow.

(Article may require a subscription.)

#medicareadvantage #cms #stars #elevancehealth

https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms

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June 7, 2024

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Oscar Continues Good Performance, Lays Out Strategy

Oscar Health reports its first quarterly net profit and hit 1.5 million enrollees in the Exchanges. It plans on investing in individual coverage health reimbursement arrangements (ICHRA) in tandem with its Exchanges offerings as well as re-entering Medicare Advantage.

Additional article: https://www.beckerspayer.com/payer/oscar-health-plans-to-double-its-membership-5-things-to-know.html

#oscar #exchanges #aca #obamacare #ichra #medicareadvantage

https://www.fiercehealthcare.com/payers/oscar-health-growth-ambitions-doubling-its-footprint-planned-ichra-products-launch-and-more

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June 6, 2024

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Medicaid Redeterminations Challenge Plan Finances

More coverage of the challenges facing Medicaid managed care with dropping enrollments and rising risk.  I pointed out this possibility in a recent blog here: https://www.healthcarelabyrinth.com/health-plan-economics-part-3-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/

(Article may require a subscription.)

#medicaid #redeterminations #healthplans managedcare

https://www.modernhealthcare.com/insurance/how-medicaid-redeterminations-process-affecting-insurers

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June 5, 2024

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Nursing Home Staffing Mandate Under Fire

President Biden’s pro-union nursing staffing mandate is now facing bipartisan opposition in Congress. The rule threatens to create a consolidation in the nursing home industry with small, independent firms selling to big chains because they cannot meet or afford standards. A lawsuit also seeks to challenge Biden’s authority to set such staffing requirements.

(Article may require a subscription.)

#nursinghomes #healthcare

https://www.modernhealthcare.com/providers/cms-nursing-home-staffing-mandate-james-lankford-joe-manchin

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June 4, 2024

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Scan Wins Lawsuit Over Star Ratings

A federal judge said the Centers for Medicare and Medicaid Services violated the Administrative Procedures Act when it deviated from current regulations to calculate Star scores for 2024.  It was a significant win for Scan and Medicare Advantage (MA) plans in general.  It also could throw 2025 bids and benefit designs as well as 2025 Star measure calculations into flux.  I will have a blog on this on Thursday.  In the meantime, check out my LinkedIn post on the issue here: https://www.linkedin.com/posts/marc-s-ryan-%F0%9F%87%BA%F0%9F%87%A6-1a99529_scan-wins-medicare-advantage-star-ratings-activity-7203759541530808320-CEd6?utm_source=share&utm_medium=member_desktop

Additional articles: https://www.beckerspayer.com/payer/scan-beats-cms-in-medicare-advantage-star-ratings-lawsuit.html and https://www.fiercehealthcare.com/payers/judge-sides-scan-health-plan-dispute-cms-over-medicare-advantage-star-ratings and https://www.healthcaredive.com/news/scan-health-plan-medicare-advantage-star-ratings-lawsuit/717976/

(Some articles may require a subscription.)

#stars #medicareadvantage #cms

https://www.modernhealthcare.com/law-regulation/scan-medicare-advantage-star-ratings-lawsuit-cms

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June 3, 2024

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BCBS KC Will Exit Medicare Advantage

Blue Cross and Blue Shield Kansas City has announced it will exit the Medicare Advantage (MA) program.  This shows the challenges created by some poor decisions by the Centers for Medicare and Medicaid Services (CMS).  I had said that many regional plans would pick up lives as major plans offload them due to investor concerns.  Will this be a trend or an exception?

#medicareadvantage #coverage #cms

https://www.fiercehealthcare.com/payers/blue-kc-exiting-medicare-advantage-market-2025-due-regulatory-demands

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May 31, 2024

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HHS Clarifies Responsibility For Change Healthcare Breach Notifcation

The Department of Health and Human Services (HHS) announced today that UnitedHealth Group would inform people about privacy breaches resulting from the Change Healthcare cyberattack. Providers, payers, and others may direct United to do so.  Previous guidance was ambiguous.  HHS FAQs were updated and clarified the issue.

HHS FAQs: https://www.hhs.gov/about/news/2024/05/31/ocr-updates-change-healthcare-cybersecurity-incident-faqs.html

(Some articles may require a subscription.)

#changehealthcare #cyberattacks #providers #payers

https://www.modernhealthcare.com/cybersecurity/change-healthcare-hack-notification-requirements-hhs

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May 30, 2024

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Big Blue Highmark Sees Bad Trends in Medicare Advantage

Pennsylvania-based Big Blue Highmark Health says it is seeing the same sort of Medicare Advantage (MA) trends other plans have reported. It sees increased utilization across inpatient and outpatient as well as rising costs of GLP-1 drugs.

#highmark #medicareadvantage #weightlossdrugs

https://www.fiercehealthcare.com/payers/highmark-health-seeing-medicare-advantage-and-glp-1-headwinds

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May 29, 2024

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Clover Health Unveils Clover Assistant As SaaS Offering

Congratulations to Clover Health by unveiling its Clover Assistant as a SaaS technology offering. Clover Assistant, now marketed as Counterpart Assistant, is available to Medicare Advantage (MA) payers and providers to improve outcomes and close care gaps.

Additional article: https://www.modernhealthcare.com/insurance/clover-health-assistant-medicare-advantage

(Some articles may require a subscription.)

#medicareadvantage #clover #healthplans #providers

https://www.fiercehealthcare.com/payers/clover-assistant-ai-tool-now-available-payers-providers

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