March 20, 2024

Both Class-Action And Provider Lawsuits Filed Against Change

Change healthcare will face both class-action lawsuits from patients as well as lawsuits from providers impacted by the Change Healthcare cyberattack. Meanwhile, provider groups, including the American Hospital association, are arguing the government and UnitedHealth Group responses have been inadequate and are pressing lawmakers to intervene with the Department of Health and Human Services (HHS).  The complaint is that advanced payments are simply not enough. Congress is also asking HHS if a bill needs to pass granting the agency flexibility in collecting advanced payments.

My blog tomorrow will be a comprehensive review of the Change cyberattack.

Additional articles: https://www.modernhealthcare.com/politics-policy/change-update-aha-financial-help-congress and https://insidehealthpolicy.com/daily-news/lawmakers-does-hhs-need-authority-allow-flexible-repayments-after-cyberattack

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

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Health Equity In MA Star Ratings Could Be Boon For Some, Hurt Others

A new health equity bonus formula will come to the Medicare Advantage (MA) star program in a few years and many are saying there will be winners and losers.  First, plans must hit a threshold for members who meet the health equity demographic for social risk factors.  Then they must perform well on Star in general. CMS will boost scores up to 0.4% for MA plans that perform well. CMS says 88% of plans would meet the demographic threshold and just 34% would receive the added bonus.

Yet another complicating factor for MA plans to achieve 4-Star or greater bonus payments.

(Article may require a subscription.)

#stars #medicareadvantage

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CBO Says Coverage of Weight-Loss Drugs Would Cost Not Save

The Congressional Budget Office (CBO) said allowing Medicare coverage of anti-obesity drugs would cost the government more than it would save in the first 10 years. It says it can find no conclusive evidence that such drugs save in other areas right now. Such drugs will be covered by Medicare for certain disease states.

I will have an upcoming blog reviewing such drugs.

(Article may require a subscription.)

#weighlossdrugs #medicare #partd #pdp #medicareadvantage

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GA Medicaid Expansion With Work Requirements Costly And Yields Little Coverage

Many are questioning the wisdom of Georgia’s Medicaid waiver that expands coverage to 100% of the federal poverty limit with work requirements.  Critics unfairly attack Georgia by featuring startup costs. They say taxpayers spent $26 million so far, with the vast majority going to administrative costs and consulting.  Yes, probably because of the standup.  That is normal.

But critics have some points. Just 3,500 have been enrolled with the expansion in Georgia so far (since July). About 25,000 were targeted in year one. And Georgia is being fairly compared to what happened to North Carolina, where a straight expansion has led to the coverage of 380,000 since March. If Georgia expanded as North Carolina did, as many as 359,000 would be enrolled.

While I favor clean expansion under federal rules, I also will not attack Georgia for their decision.  It is a state-federal partnership and states deserve to experiment if they are footing some of the bill. 

#ga #aca #obamacare #medicaid

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President And Congressional Leaders Arrive At Deal

The president and four congressional leaders arrived at a FFY 2025 spending plan to keep government open.  Given rules, it could lead to a partial shutdown before actually passed and signed.  Freedom Caucus members in the House are upset as are some Progressive Democrats. Sounds like compromise to me.


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Big Pharma Talking From Two Different Scripts

Big Pharma companies are suggesting in court that the Medicare drug price negotiations program is a “takings” with devastating impacts on property rights. It will cripple the industry and innovation.  At the same time, these same brand drug makers are telling investors not to worry – it just won’t have a huge impacts.  Huh?

#ira #drugpricing #branddrugmakers

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— Marc S. Ryan

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