CMS: 2025’s Medicare Advantage Prior Authorization Standards Are Set
Modern Healthcare says regulators will enhance Medicare Advantage "marketing, prior authorization, and network adequacy standards." The publication also reports that higher fines are working to make more hospitals disclose pricing.
Modern Healthcare:
Medicare Advantage Prior Authorization Standards Set For 2025
Regulators will enhance Medicare Advantage marketing, prior authorization and network adequacy standards for 2025, the Centers for Medicare and Medicaid Services said in a final rule Thursday. The agency set fixed compensation for agents and brokers to prohibit them from steering patients to plans that don't best suit their health needs. But CMS increased the pay cap for initial enrollments into plans by $100, versus the $31 proposed in November. (Berryman and Tepper, 4/4)
KFF Health News and Politifact:
Biden Is Right About $35 Insulin Cap But Exaggerates Prior Costs For Medicare Enrollees
The cost of insulin in the United States has risen considerably in recent years, with some estimates finding that Americans have paid around 10 times as much for the drug as people in other developed countries. But recent changes by the federal government and drug manufacturers have started to drive insulin prices down, something President Joe Biden often mentions at campaign events. (Putterman, 4/5)
Modern Healthcare:
Higher Fines Compel Most Hospitals To Disclose Prices
A year after federal regulators doubled down on price transparency requirements, most hospitals are complying with the law despite their insistence that the data isn't useful for patients. Researchers estimate at least three-quarters of hospitals have posted prices they negotiated with commercial insurers. That’s about a three-fold increase since 2021, when some hospitals argued the associated cost to compile the data, as well as its possible benefit to competitors, outweighed potential penalties. (Kacik, 4/4)
Also —
Modern Healthcare:
Sens. Elizabeth Warren, Edward Markey Target Private Equity
Federal lawmakers are pushing for more oversight of private equity investment in the healthcare industry, citing the ongoing financial struggles of Steward Health Care hospitals. The national for-profit system has been selling and closing hospitals since last year, this week shuttering New England Sinai Hospital in Stoughton, Massachusetts. Lawmakers worry more facilities will close as Steward’s outstanding rent and vendor payments pile up. (Kacik, 4/4)
Modern Healthcare:
Mergers, Private Equity Deals Keep Law Firms Busy: Survey
Healthcare consolidation is expected to remain strong in the coming months, given likely cuts in interest rates, health systems’ ongoing pursuit of financial stability and expansion opportunities, and the growing influence of private equity in care delivery. Private equity firms are increasingly acquiring physician practices and healthcare staffing firms, while hospitals are exploring mergers to reduce costs through economies of scale. (Hartnett, 4/4)
Modern Healthcare:
Marshfield Clinic Health System Layoffs Hit Hundreds Of Workers
Marshfield Clinic Health System will lay off around 360 employees it had furloughed earlier this year, a spokesperson said. The nonprofit health system in January put about 3% of its workforce on temporary, non-paid leave as it manages rising labor and supply costs, among other financial challenges. Those employees will be laid off and given severance in early May, the spokesperson for the 11-hospital system said in a statement. (Kacik, 4/4)
St. Louis Public Radio:
Mercy Health Plans 75-Bed Wentzville Hospital
Mercy Health today announced plans to build a new 75-bed hospital in Wentzville near the intersection of Interstates 70 and 64. The Chesterfield-based Catholic health system today submitted a letter of intent to build the $650 million facility to the state’s Department of Health and Senior Services, which oversees and regulates the construction of new hospitals. (Fentem, 4/5)
Modern Healthcare:
Change Healthcare Faces 2 Dozen Lawsuits Related To Breach
UnitedHealth Group is looking to simplify the legal battle over the Change Healthcare cyberattack. The conglomerate, which operates Change Healthcare through its Optum subsidiary, wants a judicial body to assign two dozen potential class action lawsuits to the U.S. District Court for the Middle District of Tennessee in Nashville, according to a brief filed Wednesday. (Berryman, 4/4)
