June 11, 2024

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


Hospitals Raise Issues With Medicare Rate Hike And Requirements

Hospitals pushed back on the Centers for Medicare and Medicaid Services’ (CMS) proposed regulatory changes and rate hikes. Hospitals raised concerns about new quality reporting requirements and changes to medical residency training programs.  It claimed the 2.6% rate hike was inadequate. At the same time, hospitals are opposing site-neutral payments, which would save the system and patients huge sums.

#hospitals #medicare


Humana Finds VBC Payments Impact Kidney Care

Humana has been a leader in developing value-based care (VBC) payments in the Medicare Advantage (MA) world.  Its latest study finds that VBC payments reduce costs for chronic kidney disease (CKD) and end-stage renal disease (ESRD).

#humana #vbc


Missouri And Texas Could Face Funding Cuts Over Government Program Application Processing

The Centers for Medicare and Medicaid Services (CMS) is telling Texas and Missouri they could face funding cuts based on their processing of government program applications.

(Article may require a subscription.)

#tx #mo #cms #medicaid #chip


States Want Ability To Police Pharmacy Benefits Managers

Interesting request from a bipartisan group of state attorneys general asking the U.S. Supreme Court to take a case they say limits states’ ability to police pharmacy benefit managers (PBMs).  States are frustrated by the vast control three major PBMs have and believe federal oversight is lacking. A lower court says federal laws trump state laws on PBM oversight. 

(Article may require a subscription.)

#pbms #drugpricing


Biden Proposes Medical Debt Be Erased From Credit Reports

In some election-year politicking, President Biden has proposed that medical debt not be a factor in determining a credit score.  While the timing is suspect, I am a believer given the predatory nature of hospital and provider (many of them owned by private equity firms) lawsuits seeking to recoup exorbitant billed charges.

Additional article: https://kffhealthnews.org/news/article/biden-administration-plan-remove-medical-debt-credit-scores/ and https://thehill.com/policy/healthcare/4716225-biden-administration-moves-to-ban-medical-debt-from-credit-reports/mlite/

(Some articles may require a subscription.)

#medicaldebt #healthcare


Independent Pharmacies Impacted By New Medicare Drug Rule

Independent pharmacies have raised issues with the impact of a new federal Medicare rule that requires the pass-through of all concessions and discounts (except rebates) at the point of sales.  While chains can handle it, independents rightfully have raised issues with the impact it has had on cash flow.  The Biden administration champions the change as a break for seniors and the disabled in Medicare.  But it also is a good example of the impact that regulations have on small business.

#cms #pharmacies


Nursing Home Staffing May Be Overturned In The Senate

A resolution aimed at overturning President Biden’s controversial nursing home staffing rule could pass the Senate.  While there is bipartisan concern in the House, no word yet on its chances there.

#nursinghomes #staffing


Marketing Organizations Oppose New Rules

A good article on the huge debate on new Medicare marketing rules.  The Centers for Medicare and Medicaid Services (CMS) proposed rather strict rules related to compensation for agents and upstream brokers/third party marketing organizations (TPMOs).  Insurers came out in opposition to the rule as did TPMOs.  At least one TPMOs is suing to stop the rule. Plans should not oppose the change.  CMS is absolutely right on this issue.  They are protecting Medicare beneficiaries’ best interests. The practices of TPMOs, with many plans’ concurrence through unseemly compensation agreements, is clearly abusive and works against members’ best interests. Plans should focus on issues of principle.

(Article may require a subscription.)

#tpmos #medicare #marketing


Biden Expands Navigator Funding

The Biden administration announced new navigator funding for the Exchanges.  It also touted the over 21 million now enrolled in the program.  I also noticed an interesting statistic. While Medicaid enrollment is down by more than 10 million from its high in March 2023, enrollment in March 2024 was about 12 million higher than in February 2020.  Still, we will see an increase in our uninsured rate due to the losses.

(Article may require a subscription.)

#coverage #medicaid #exchanges #aca #obamacare


Cigna Pushed Back On Need For Acquisition To Meet Financial Targets

Cigna Chief Financial Officer Brian Evanko says it does not need an acquisition to meet its financial targets.  Cigna bucked the trend by announcing it will shed its Medicare Advantage (MA) book of business due to financial and operational issues. Speculation is that Cigna will eventually gobble up Humana, an MA-dominant business.

#medicareadvantage #cigna #humana


— Marc S. Ryan

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