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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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May 28, 2024

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Biden On Healthcare Attack In Election 2024

President Joe Biden is attacking former President Donald Trump on his healthcare stances and indicating he wants to repeal the Affordable Care Act (ACA). Polling shows Biden is better trusted on healthcare and this could help him in swing areas of the country.

See my blog on this topic: https://www.healthcarelabyrinth.com/election-update-and-the-potential-role-of-healthcare-issues/ .   

(Article may require a subscription.)

#election2024 #healthcare #aca #exchanges #medicaid #obamacare

https://www.modernhealthcare.com/politics-policy/joe-biden-ad-aca-affordable-care-act-donald-trump-health-issues

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May 27, 2024

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The major healthcare news services were off today for Memorial Day. Please check out the blog we published today on my modest proposal for healthcare reform: https://www.healthcarelabyrinth.com/a-modest-election-year-proposal-for-healthcare-reform/

— Marc S. Ryan

May 24, 2024

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Nursing Homes Sue On Staffing Ratios

Nursing home associations are suing in federal court to overturn a new staffing ratio rule. The rule will lead to a massive consolidation in the industry and the loss of independent homes.

Additional articles: https://www.modernhealthcare.com/providers/nursing-home-staffing-mandate-ahca-lawsuit and https://insidehealthpolicy.com/daily-news/nursing-homes-sue-cms-over-staffing-rule-aarp-backs-agency

(Some articles may require a subscription.)

#nursinghomes #staffing

https://www.fiercehealthcare.com/providers/nursing-home-groups-file-lawsuit-block-cms-staffing-mandate

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May 23, 2024

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Physician Pay Up; Docs Want Medicare Fix

Physician pay increased by 5.9% in 2023 after dropping 2.4% in 2022. At the same time, physician groups were on Capitol Hill lobbying for a Medicare physician payment fix and more changes to prior authorization. Some indicated that it was hard to compete against hospital-owned docs because of higher payments. The independent docs want site-neutral payments implemented.

Additional article: https://www.fiercehealthcare.com/providers/20-highest-paid-specialties-2023-doctors-see-6-boost-pay-doximity

#physicians #rates #medicareadvantage #medicare #priorauthorization #siteneutral

https://www.medpagetoday.com/practicemanagement/reimbursement/110302

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May 22, 2024

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Providers Lose 340B Lawsuit Appeal To Drug Makers

A U.S. Court of Appeals ruled that drug makers can limit and impose conditions on pharmacies participating in the 340B drug discount program. The federal government had sided with providers, but a federal court ruled against that position.

I am no friend of drug makers but this ruling is a good one.  The 340B program has been corrupted and abused by providers. It is not fulfilling its mission of getting discounted drugs to the most vulnerable. 

Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/second-appeals-court-rules-drug-makers-can-impose-340b-restrictions

(Some articles may require a subscription.)

#340b #drugmakers #hospitals #providers

https://www.healthcaredive.com/news/appellate-court-rules-drugmakers-340b-novartis-pharmacies-specialty/716814

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