CMS Recalculates Some SY 2026 Ratings
CMS this evening announced it is recalculating some contracts’ SY 2026 Star Ratings based on the better of the current ratings or the measures included in the recent Clover decision. A judge struck up to 20 measures. CMS went out of its way to note that this does not set policy for SY 2027 ratings or beyond. I still expect an appeal or other intervention to bring back a fulsome Star program.
#stars #quality #cms #medicareadvantage #partd #pdp
DOJ Sues NY Over Fraud
The Department of Justice (DOJ) is suing the New York State Department of Health (DOH), the state’s Medicaid director, and a company operating a $10 billion home health program.
The Justice Department accused home health agency Public Partnerships, LLC (PPL) of making false or misleading statements about its ability to take over and run the state’s Consumer Directed Personal Assistance Program (CDPAP). DOJ also says DOH awarded PPL the contract after conducting a sham bid process and did not hold the company accountable.
#fwa #ny #medicaid
https://thehill.com/policy/healthcare/5928960-doj-sues-new-york-health/
Senate Dems Seek To Usurp Drug Price Issue From Trump
Senate Democrats released a skeletal plan and request for information to lower prescription drug costs. The move is meant to counter the large-scale effort undertaken by President Trump. Democrats want to push expanded Medicare drug price negotiations and include international reference pricing in the program. Trump has already proposed models for this in both Medicare and Medicaid.
#drugpricing #midterms #trump
https://thehill.com/homenews/senate/5926593-senate-democrats-prescription-drug-plan/
— Marc S. Ryan
