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Judge Rules CMS Miscalculated Medicare Star Rating for SCAN Health

June 5, 2024 Morning Briefing

SCAN Health Plan had sued CMS, saying regulators didn’t properly calculate the insurer’s Medicare Advantage rating. The decision could have industrywide implications, Modern Healthcare says.

CMS: 2025’s Medicare Advantage Prior Authorization Standards Are Set

April 5, 2024 Morning Briefing

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.

Under Trump, Privately Run Health Care Plans Favored Over ACA And Medicaid

November 7, 2024 Morning Briefing

In the aftermath of the election, health care companies that offer federally funded plans, like ACA and Medicaid, are likely to suffer, while private ones, like Medicare Advantage, will likely benefit from the Republican win. Also, more about what to expect from the Trump presidency.

Era of ‘Free’ Covid Vaccines, Test Kits, and Treatments Is Ending. Who Will Pay the Tab Now?

By Julie Appleby February 10, 2023 KFF Health News Original

Insurers, employers, and taxpayers will all be affected as drug manufacturers move these products to the commercial market.

CMS To End Advance-Payment Program For Those Affected By Hack

June 18, 2024 Morning Briefing

The program, launched in March in the aftermath of the Change Healthcare cyberattack, sent advance payments to providers whose operations were disrupted. CMS also announced a do-over of 2024 quality scores for Medicare Advantage plans.

UnitedHealth Doctors Got Diagnoses Checklists To Boost Medicare Payouts

January 2, 2025 Morning Briefing

The Wall Street Journal reports how UnitedHealth provided lists of potential, often obscure diagnoses to its doctors and forced them to weigh in on them for each Medicare Advantage patient, in order to capitalize on the government system that pays private insurers based on how sick doctors say a patient is.

AARP’s Billion-Dollar Bounty

By Fred Schulte June 6, 2022 KFF Health News Original

With its latest venture into primary care clinics, is America’s leading organization for seniors selling its trusted seal of approval?

Morning Briefing for Thursday, November 30, 2023

November 30, 2023 Morning Briefing

Medicare Advantage, a possible Cigna-Humana merger, covid wastewater tracking, Medicaid expansion, women’s health, and more are in the news.

What the Health? From KFF Health News: Newly Minted Doctors Are Avoiding Abortion Ban States

May 9, 2024 Podcast

For the second year in a row, medical school graduates across specialties are shying away from applying for residency training in states with abortion bans or significant restrictions, according to a new study. Meanwhile, Medicare’s trustees report that the program will be able to pay its bills longer than expected — which could discourage Congress from acting to address the program’s long-term financial woes. Lauren Weber of The Washington Post, Joanne Kenen of the Johns Hopkins University schools of nursing and public health and Politico Magazine, and Anna Edney of Bloomberg News join KFF Health News’ Julie Rovner to discuss these stories and more.

Trump Chooses Dr. Mehmet Oz To Run Medicare And Medicaid Agency

November 20, 2024 Morning Briefing

A former cardiothoracic surgeon and professor at Columbia University, Dr. Oz is better known to the public as a TV personality and has no experience running a government agency. If confirmed as the CMS administrator, he would be influential in major policies around how states run their Medicaid programs and regulations on Medicare Advantage private plans.

What the Health? From KFF Health News: Health Funding in Question in a Speaker-Less Congress

October 12, 2023 Podcast

A bitterly divided Congress managed to keep the federal government running for several more weeks, while House Republicans struggle — again — to choose a leader. Meanwhile, many people removed from state Medicaid rolls are not finding their way to Affordable Care Act insurance, and a major investigation by The Washington Post attributes the decline in U.S. life expectancy to more than covid-19 and opioids. Lauren Weber of The Washington Post, Victoria Knight of Axios, and Sarah Karlin-Smith of the Pink Sheet join KFF Health News chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews physician-author-playwright Samuel Shem about “Our Hospital,” his new novel about the health workforce in the age of covid.

4.2% Medicare Pay Raise Coming To Nursing Homes In Fiscal 2025

August 1, 2024 Morning Briefing

The rate is higher than the 4.1% the Centers for Medicare and Medicaid Services proposed in March. Also in the news: Humana predicts losing a few hundred thousand Medicare Advantage members next year; Google is not renewing its contract with Amazon One Medical for staff care; and more.

House Passes Bill Barring Use Of QALY Metric In Federal Health Programs

February 8, 2024 Morning Briefing

The legislation would ban the use of quality-adjusted life years indexes when valuing medicines for federal health programs such as Medicaid, Medicare Advantage, and VA Health Care.

KHN’s ‘What the Health?’: News You Might Have Missed

April 14, 2022 KFF Health News Original

Congress is in recess, so the slower-than-average news week gives us a chance to catch up on underreported topics, like Medicare’s coverage decision for the controversial Alzheimer’s disease drug Aduhelm and ominous new statistics on drug overdose deaths and sexually transmitted diseases. Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, and Alice Miranda Ollstein of Politico join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

Morning Briefing for Tuesday, November 7, 2023

November 7, 2023 Morning Briefing

Election Day, Medicare Advantage rules, gun violence, virus surveillance, abortion law, opioids, smoking, and more are in the news.

Morning Briefing for Monday, October 23, 2023

October 23, 2023 Morning Briefing

Opioid settlements, Medicare Advantage, finding covid shots, Medicaid enrollments, AI chatbots, dementia, and more are in the news.

What the Health? From KFF Health News: GOP House Opens With Abortion Agenda

January 12, 2023 Podcast

Leaders of the new Republican-led U.S. House kicked off their legislative agenda with two bills supported by anti-abortion groups. While neither is likely to become law, the move demonstrates how abortion will continue to be an issue in Washington. Meanwhile, as open enrollment for the Affordable Care Act nears its end in most states, the number of Americans covered by the plans hits a new high. Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these topics and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

4 Months After Cyberattack, VA Grapples With Paying Providers

June 26, 2024 Morning Briefing

The attack hit a third-party company that manages some processes for the Department of Veterans Affairs. Officials say they’re still working to clear a backlog of payments to pharmacies and other providers. Also in the news: AI use by Medicare Advantage insurers.

Morning Briefing for Thursday, October 19, 2023

October 19, 2023 Morning Briefing

Social Security clawbacks, maternal health, NIH nominee hearing, Medicare Advantage, Paxlovid cost, and more are in the news.

Medicare Pay Cuts Will Hurt Seniors’ Care, Doctors Argue

By Michael McAuliff December 20, 2022 KFF Health News Original

New reductions in Medicare payments in 2023 will drive more doctors away from accepting Medicare patients, physicians say. They are again pushing back on efforts largely designed to control government spending.

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