Some Hope For Medicaid Hikes
Medicaid managed care plans have argued that risk in the program has gone up with the Medicaid unwinding (redeterminations) and rates have become inadequate to serve remaining enrollees. A number of state Medicaid directors are now saying mid-year rate hikes could address the financial woes of plans.
The Alliance of Community Health Plans is urging the current administration to urge states to re-evaluate current rates.
Notwithstanding the positive signs, states will have a hard time affording major hikes given the drying up of extraordinary federal revenue given to states during the COVID pandemic.
(Article may require a subscription.)
#medicaid #redeterminations #rates #healthplans #managedcare
Article Recaps Tough Year for UnitedHealth Group
Becker’s recounts the very tough year seen by UnitedHealth Group, including the Change Healthcare cyberattack, government investigations, and the tragic killing of executive Brian Thompson.
#unitedhealthcare #tragedy #changehealthcare #cyberattacks
https://www.beckerspayer.com/payer/an-unimaginable-year-for-unitedhealth.html
MA Does Not Offer Comprehensive Dental Benefits
A study in JAMA finds that while most Medicare Advantage (MA) plans offer dental benefits, few are comprehensive. More than 85% of MA plans offered dental benefits, but only 8% offered comprehensive ones.
What seems to be missed is that MA at least is offering coverage that is not in traditional Medicare.
#dentalcare #medicareadvantage
Aetna Charges Radiology Group With Abuse of Arbitration
A prominent insurer is pushing back on the clearly slanted No Surprises Act arbitration process. Data show that providers win 75% of cases and awards make payments that are higher than before the act went into effect.
Aetna is suing Radiology Partners, one of the country’s largest networks of radiology practices, arguing radiologists in Florida increased prices and abused the new federal process that settles out-of-network medical claims. Aetna argues network contracts existed. As well, before using the out-of-network arbitration, Aetna says the group piggybacked off of an inappropriate network contract that gained it tens of millions in payments.
(Article may require a subscription.)
#aetna #providers #nsa #nosurprisesact #surprisebilling
Nursing Homes Prepare – Or Not – For Staffing Requirement
Nursing home operators are going between preparing for the new staffing ratios in 2025 and campaign against it. Many are assuming that the Trump administration will seek to rescind the regulation.
Most homes are battling day-to-day staffing challenges and cannot focus on the mandate. The regulation would cost homes around $4.3 billion per year. No federal funding was earmarked.
(Article may require a subscription.)
#nursinghomes #staffing
https://www.modernhealthcare.com/policy/cms-staffing-rule-nursing-homes-2025
Next Possible Cures Act Outlined
Reps. Dianna DeGette, D-CO, and Larry Bucshon, R-IN, released a discussion draft outlining priority areas for a potential “Cures 2.1” legislation. It would build on their earlier legislation to speed up development and coverage of new therapies and expanding coverage of preventative medicines. Inside Health Policy has three articles on the discussion document.
Additional articles: https://insidehealthpolicy.com/daily-news/degette-bucshon-permanent-telehealth-will-play-significant-role-cures-21 and https://insidehealthpolicy.com/daily-news/cures-21-could-standardize-gene-therapy-payment-models
(Articles may require a subscription.)
#curesact #healthcare #healthcarereform #prevention
— Marc S. Ryan
