CMS Appeals Clover Decision
Two major things in the past few days:
The Centers for Medicare and Medicaid Services (CMS) updated the Medicare Plan Finder website and landscape files with the “better of” recalculated measures vs. original. This tells us exactly how many contracts got increases and impacts. Previous estimates suggested about 10% got an increase, with others the same or held harmless.
CMS has appealed the Clover decision. We don’t have details yet but I will update as more is known. This was totally expected. We will see if they have appealed on both the statutory and regulatory deficiencies or just regulatory.
Additional articles: https://www.fiercehealthcare.com/regulatory/cms-appeals-court-decision-behind-2026-ma-star-ratings-recalculations and https://www.healthcaredive.com/news/cms-appeals-clover-health-medicare-advantage-stars-lawsuit-cms/826003/ and https://www.beckerspayer.com/legal/cms-appeals-clovers-medicare-advantage-star-ratings-win/
(Some articles may require a subscription.)
#cms #medicadvantage #stars #quality
https://www.modernhealthcare.com/insurance/mh-cms-appeal-clover-medicare-advantage-ratings/
Commercial Insulin Cost-Sharing Cap Advances
A bipartisan bill to cap the cost of insulin at $35 for people with private health insurance advanced through a key Senate committee Wednesday. Its future remains uncertain.
#insulin #drugpricing #branddrugmakers #healthplans
https://thehill.com/policy/healthcare/5984156-senate-committee-advances-insulin-cap-bill
— Marc S. Ryan
