Provider Directory Rule For Medicare Advantage
Medicare Advantage (MA) insurers will be required to submit provider directories to the Centers for Medicare and Medicaid Services (CMS) next year under a final rule issued Thursday. The provider information will be added to the Medicare Plan Finder. CMS will issue an operational guide to outline how to prepare and submit the directory.
MA plans will have to submit their network lists by Jan. 1 and then once a year. Updates must be made every 30 days to reflect changes in provider participation. Insurers will not have to attest that they meet network adequacy standards.
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#medicareadvantage #providers #cms
CBO Again Projects Coverage Losses
The Congressional Budget Office (CBO) issued a new assessment of the Exchange premium subsidy enhancements extension. It found making the enhancements permanent would cost $350 billion over ten years (added to the deficit) and boost the insured population by 3.8 million people in a decade. These numbers are based on passing the legislation before September 30. Passage after that date would mean a smaller increase in 2026 enrollment and lower costs to the government. In part this is due to an expected surge in premiums for 2026. CBO estimates gross premiums would not be adjusted downward after the start of open enrollment on Nov. 1 in most Exchanges.
CBO also said nullifying a June 2025 final rule aimed at promoting “marketplace integrity” would mean $40.3 billion increase in deficits over 2026 to 2035 but add further to the insured estimate. Removing other restrictions would increase coverage by 2.9 million in 2035 and further increase the deficit by $271.9 billion.
A new Urban Institute analysis on the same subject says the effects of the reconciliation bill, the integrity rule, and no premium subsidy enhancement extensions will mean the individual market is expected to decrease from 25.1 million to 17.4 million.
In other news, Kaiser Health News covers the Trump administration’s recent announcement of an expansion of catastrophic coverage in the Exchanges.
Additional article: https://www.beckerspayer.com/policy-updates/subsidy-extension-would-increase-coverage-but-costs-350b-cbo/ and https://kffhealthnews.org/news/article/obamacare-catastrophic-plans-health-insurance-aca-trump/
#exchanges #healthcare #coverage
Appeals Court Bars Mass Healthcare Layoffs
An appeals court has denied the Trump administration’s request to resume mass layoffs and restructuring at federal health agencies. The lawsuit brought by Democratic-led states will now move ahead.
#hhs #cms #nih #cdc
https://thehill.com/regulation/court-battles/5509828-appeals-court-blocks-health-layoffs/?tbref=hp
— Marc S. Ryan
