Government Funding Stopgap
House Republicans will vote this week on a shorter, 7-week funding resolution for FFY 2026 (which begins October 1) that includes some critical healthcare extensions, but nothing on extending the Exchange premium subsidy enhancements. The bill would need a simple majority in the House but 60 votes in the Senate.
Congressional Democrats have suggested they may not support the measure unless it includes greater healthcare funding, including a rollback of some budget reconciliation bill cuts and extension of the subsidies.
Additional articles: https://www.fiercehealthcare.com/regulatory/republicans-unveil-7-week-stopgap-hospital-funding-telehealth-extensions-no-aca-premiums and https://www.beckershospitalreview.com/finance/aca-subsidy-extension-left-out-of-7-week-stopgap-funding-bill/
(Some articles may require a subscription.)
#governmentshutdown #congress #healthcare
Hospitals Attack Aetna Proposed Inpatient Policy
The hospital lobby has sent Aetna a letter urging it to rescind its planned “level of severity inpatient payment” Medicare Advantage (MA) policy, which is set to go into effect November 15. Under the policy, Aetna will approve inpatient stays without a medical necessity review but pay the claim at a lower severity rate. If the inpatient stay meets Aetna’s supplemental guidelines, the insurer will pay the claim according to the hospital’s agreement. The policy covers emergent or urgent inpatient stays greater than one midnight.
Aetna says this is meant to expedite payment to providers, but providers argue the policy is not consistent with MA prior authorization requirements or the new “two midnight provision” handed down by the Centers for Medicare and Medicaid Services for a 2024 effective date. It complains this is a way to get around paying for inpatient stays in favor of observation days.
Additional article: https://www.beckerspayer.com/payer/medicare-advantage/hospital-group-pushes-aetna-to-repeal-inpatient-reimbursement-policy/
#hospitals #healthplans #priorauthoriation #claimsdenials
Will Medicare Advantage Prior Auth Bill Finally Pass?
MedPage Today has an interesting article on the Improving Seniors’ Timely Access to Care Act. The bill would make several prior authorization and other reforms. The bill has been around for several years but has failed to pass because of its price tag. Since that time, many of the more expensive provisions have been put in place via regulation. That means the bill now is priced at zero. It has strong bipartisan support, but will it finally pass?
#medicareadvantage #priorauthorization #providers
https://www.medpagetoday.com/practicemanagement/reimbursement/117494
NCQA Ratings Announced
Right around this time each year, the National Committee for Quality Assurance (NCQA), the nation’s quality organization, releases its annual ratings of health plans. It should not be confused with the Medicare Advantage (MA) Star ratings released in October, although NCQA does rate plans across lines of business (including MA).
NCQA awarded 11 of 998 plans its highest 5 Sar rating — eight were commercial plans and three were Medicare plans. They included Blue Cross and Blue Shield of Massachusetts, UPMC Health Plan and several Kaiser Foundation Health Plans. An additional 55 plans earned a 4.5-star rating. Most plans ranked between 3 and 4 stars, same as in 2024.
#ncqa #ratings #quality #healthplans
— Marc S. Ryan
