Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

FEBRUARY 5, 2024

Humana reaffirmed its guidance in the face of likely cuts in Medicare Advantage payment rates for 2025, despite saying the proposed decrease was higher than it expected.

Medicare 97

Medicare Medicare 97

Healthcare IT News - Telehealth

APRIL 22, 2024

Medicare was the first to cover RPM. If the AMA approves the changes under consideration, and Medicare follows suit, which it usually does, then providers who make modifications and expand their RPM programs to fit the new codes will gain the most benefits for their patients and their clinics. However, the federal agency often does so.

Medicare 159

Medicare Medicare Medicaid Medicaid 159

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1]. The cost to Medicare Part D would be $26.8

Medicare 59

Medicare Medicare COVID-19 Hospitals 59

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1]. The cost to Medicare Part D would be $26.8

Medicare 52

Medicare Medicare COVID-19 Hospitals 52

Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. The transformational changes in 2025 are highlighted below. CGDP will be replaced with a new Manufacturer Discount Program (MDP) in 2025.

Medicare 52

Medicare Medicare Compliance FDA 52

Fierce Healthcare

JANUARY 31, 2024

Cigna will sell off its Medicare business to Health Care Service Corporation in a deal valued at $3.7 HCSC will acquire Cigna's Medicare Advantage, Part D, supplemental benefits and CareAllies businesses, and the parties expect the deal to close in the first quarter of 2025. billion, the company announced Wednesday.

Medicare 124

Medicare Medicare 124

Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. ACOs currently participating in the MSSP may also participate in the Flex Model by applying to the MSSP as a renewal applicant.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Fierce Healthcare

NOVEMBER 3, 2021

Part D, Medicare Advantage drug plans must install cost-sharing cap by 2025 in new drug price bill. Wed, 11/03/2021 - 17:25.

Medicare 116

Medicare Medicare 116

Healthcare Dive

FEBRUARY 8, 2024

As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.

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Medicare Medicare 170

Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

Medicare 52

Medicare Medicare Due Diligence Health Insurance 52

Healthcare Dive

SEPTEMBER 12, 2023

The partnership, which Walgreens plans to launch in ACO REACH in 2024 and Medicare Advantage in 2025, is the retail giant’s first significant move in the healthcare space since CEO Roz Brewer departed earlier this month.

Doctors 179

Doctors Medicare Medicare 179

Fierce Healthcare

MARCH 12, 2024

President Joe Biden's 2025 budget did not just touch upon cybersecurity, the drug price negotiation program and Medicare solvency, as the plan also suggested policy for mental health, health equity | Many significant policy items in Biden's proposed 2025 fiscal year budget don't grab the initial headlines, but he's looking to make (..)

Medicare 124

Medicare Medicare 124

Healthcare Dive

MAY 17, 2022

The payer plans to open about 100 new value-based primary care clinics for Medicare patients between 2023 and 2025 through the latest deal.

Medicare 263

Medicare Medicare 263

Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

Medicare 40

Medicare Medicare Due Diligence Health Insurance 40

Fierce Healthcare

APRIL 2, 2024

States now can add routine adult dental services as an essential health benefit, the Centers for Medicare & Medicaid Services announced in its 2025 Notice of Benefit and Payment Parameters fina | In its annual Notice of Benefit and Payment Parameters final rule, CMS prioritized dental and prescription drug benefits, network adequacy standardization (..)

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ACA Medicaid Medicaid Medicare 110

Healthcare Dive

MARCH 15, 2023

Under the Inflation Reduction Act, pharma companies owe rebates to Medicare for price increases they take that exceed inflation. But they won’t need to pay until 2025.

Medicare 130

Medicare Medicare 130

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. Standards for benchmarking and data completeness for the Medicare CQM collection type will mirror the MIPS benchmarking and scoring policies.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

Fierce Healthcare

FEBRUARY 7, 2024

A spike in care utilization among seniors and proposed Medicare Advantage rates that payers find less than satisfactory have dominated the conversation during the current run of industry earnings c | A spike in care utilization among seniors and proposed Medicare Advantage rates that payers find less than satisfactory have dominated the conversation (..)

Medicare 52

Medicare Medicare 52

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. million per year starting in 2025 for PY 2018 from extrapolated recoveries.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Fierce Healthcare

AUGUST 21, 2023

The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for presc | New draft guidance gives a blueprint for pharmacies to begin offering monthly payments on prescription drugs starting in 2025.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

MRO Compliance

OCTOBER 23, 2023

In 2025, ACOs will be required to shift from traditional quality reporting via the CMS Web Interface to electronic clinical quality measures (eCQMs), marking a significant transition in their reporting process. Reporting via eCQM is optional in 2023 and 2024, but it becomes mandatory in 2025.

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Payment Systems Medicare Medicare 130

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year. CERT Testing is planned to begin on July 1, 2024.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Health Care Law Brief

FEBRUARY 8, 2024

This year’s Health and Mental Hygiene Bill (“HMH Bill”) (part of the Governor’s FY 2025 Executive Budget) proposes a $233 billion balanced budget, which includes $35.5 billion to fund Medicaid, $4.8 billion to address serious mental illness and $6 billion in federal funding through the 1115 Waiver.

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

Health Care Law Brief

FEBRUARY 2, 2024

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). The Waiver Amendment was approved on January 9, 2024, by the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115(a) of the Social Security Act and will expire on March 31, 2027.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Natalia Mazina

OCTOBER 30, 2022

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ). CMS does not anticipate that these new prices will result in lower pharmacy reimbursements. .

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Hanys

JANUARY 12, 2024

Recently, HANYS submitted comments to CMS on proposed changes to the Medicare Advantage and Part D programs and to CMS and HHS on HHS' proposed CY 2025 Payment Rule.

Medicare 40

Medicare Medicare 40

Healthcare IT News - Telehealth

JUNE 20, 2023

A bipartisan group of legislators has reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act – first introduced in 2016 – to expand opportunities and coverage for telehealth through Medicare. This is the second time the bill has been reintroduced. Mike Thompson (D-Calif.)

Medicare 129

Medicare Medicare COVID-19 Doctors 129

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

Medicare 52

Medicare Medicare Nurses Medicaid 52

Hall Render

AUGUST 11, 2023

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Hall Render

MAY 30, 2023

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024. CMS sees this as a 3.7%

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Medicare 40

Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Background Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Healthcare IT Today

FEBRUARY 20, 2023

in 2025, with upside in 2025 based on the successful resolution of its Medicare Stars Ratings mitigation efforts. About Oak Street Health Founded in 2012, Oak Street Health is a network of value-based primary care centers for adults on Medicare. And we do it all with heart, each and every day.

Medicare 79

Medicare Medicare Nurses Health Outcomes 79

HIT Consultant

DECEMBER 12, 2023

In fact, by 2025, more than 70 million U.S. Its use has increased over the past decade, but still, only about 13% of dialysis patients currently take advantage of in-home dialysis , despite studies showing that it has similar outcomes to in-patient treatment, greater patient satisfaction and reduced Medicare costs.

Patient Satisfaction 119

Patient Satisfaction COVID-19 Payment Systems Doctors 119

Healthcare IT News - Telehealth

JANUARY 13, 2022

However, earlier this month, it enforced changes to the Medicare Benefits Schedule for telehealth items , including the termination of 128 items, which some healthcare leaders warned would bring major consequences to patients. million) project is also led by Monash University and is expected to deliver solutions by 2025. million ($1.5

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Health Cooperatives Governance Doctors Medicare 131