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.
Morning Briefing for Wednesday, October 11, 2023
October 11, 2023
Morning Briefing
Abortion law, opioids, Medicare Advantage, covid, Medicaid enrollment, telehealth rules, sepsis, mental health, and more are in the news.
Insurers Overcharging Taxpayers For Medicare Advantage, Doctors Allege
October 11, 2023
Morning Briefing
The overcharging sum, Physicians for a National Health Program alleges, could be at least $88 billion a year. Meanwhile, Medicare Advantage’s predictive AI software is in the spotlight for cutting off care to people who need it. Also: a federal program to cut sepsis deaths, open enrollment, and more.
Facing Physician Shortage, CMS Opens 200 More Residency Slots
November 25, 2024
Morning Briefing
An estimated 70% of the slots were set aside for psychiatry or primary care. Other industry news is about Black doctors, UnitedHealth’s Medicare Advantage ratings, telehealth, at-home care, and more.
KFF Health News' 'What the Health?': Congress Kicks the (Budget) Can Down the Road. Again.
November 16, 2023
Podcast
Congress narrowly avoided a federal government shutdown for the second time in six weeks, as Democrats came to the rescue of divided House Republicans over annual spending bills that were supposed to be finished by Oct. 1. But the brinksmanship is likely to repeat itself early in 2024, when the next temporary spending patches expire. Meanwhile, a pair of investigations unveiled this week demonstrate how difficult it still is for seniors to get needed long-term and rehabilitation care. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News’ Julie Rovner to discuss these issues 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.
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.
Morning Briefing for Wednesday, September 27, 2023
September 27, 2023
Morning Briefing
Covid vaccine attitudes, shutdown watch, ARPA-H hubs, Medicare Advantage premiums, abortion law, drug pricing, and more are in the news.
Medicare Open Enrollment Kicks Off: Be Aware Of Plan Changes For 2025
October 15, 2024
Morning Briefing
Enrollment in a 2025 Medicare plan opened for beneficiaries today. News outlets focus on an array of changes that could lead to “benefit disruption” which consumers should know about, in particular around Medicare Advantage choices and the prescription payment plan.
CMS-Proposed Rules Would Cap Medicare Advantage Broker Incentives
November 7, 2023
Morning Briefing
The Centers for Medicare and Medicaid Services are launching a second-wave effort to target Medicaid Advantage marketing practices in an effort to ensure older Americans have access to Medicare supplemental benefits and drug coverage.
Even Well-Intended Laws Can’t Protect Us From Inaccurate Provider Directories
By Bernard J. Wolfson
July 26, 2022
KFF Health News Original
State and federal laws require health plans to offer accurate lists of participating doctors and facilities, but consumers still struggle to get timely appointments with providers.
Report: UnitedHealth’s Tactics To Make Medicare Advantage Patients ‘Look As Sick As Possible On Paper’
October 16, 2024
Morning Briefing
The latest story in Stat’s investigation of UnitedHealth’s influence looks at the company’s strategy to enlist its doctors to pile moneymaking diagnoses onto patients covered by Medicare Advantage, using incentive tools like $10,000 bonuses and a doctor leaderboard. Other Medicare news is on low-cost drugs, value-based care, and more.
CMS: Medicare Advantage Premiums To Slightly Rise Next Year
September 27, 2023
Morning Briefing
The Centers for Medicare and Medicaid Services estimates that Medicare Advantage plan premiums will increase from $0.64 per month on average in 2024. Separately, GAO says that CMS does not have useful data on private equity investments in the nursing home industry.
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.
KHN’s ‘What the Health?’: Leaked Abortion Opinion Rocks Washington’s World
May 5, 2022
KFF Health News Original
The unprecedented early leak of a Supreme Court draft opinion that would overturn the landmark abortion-rights ruling Roe v. Wade has heated the national abortion debate to boiling. Meanwhile, the FDA, after years of consideration, moves to ban menthol flavors in cigarettes and cigars. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Shefali Luthra of the 19th, and Jessie Hellmann of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews KHN’s Paula Andalo, who wrote the latest KHN-NPR “Bill of the Month” episode about a family whose medical debt drove them to seek care south of the border.
Senate Finance Panel Grills Medicare Advantage Brokers Over Incentives
October 19, 2023
Morning Briefing
The Senate Finance Committee held a hearing Wednesday, questioning national insurance brokers about their practice in guiding Medicare Advantage enrollees through choosing among many plan options. Financial incentives and privacy were among the issues discussed.
KFF Health News' 'What the Health?': 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.
Cigna To Sell Its Medicare Business To Health Care Service Corp.
February 1, 2024
Morning Briefing
Cigna is shedding its troubled Medicare Advantage, Medigap, and Medicare part D plans that cover 3.6 million people. The business will be sold to Health Care Service Corp., a Blue Cross Blue Shield insurer.
‘Big 3’ Medicare Advantage Insurer Algorithms Deny 1 in 4 Post-Acute Care Requests: Probe
October 17, 2024
Morning Briefing
A Senate investigation found the three largest Medicare Advantage insurers have been increasingly denying seniors claims since adopting AI and algorithms to help streamline the approval process, reaching a nearly 1 in 4 denial rate since 2022.
Health Care Providers Indirectly Hit By Medicare Advantage Star Rating Slips
November 21, 2023
Morning Briefing
The argument runs thus: Declining ratings prompt insurers to seek cost savings that then impact health providers. Separately, worries emerge that new nursing home ownership transparency rules may lead to private equity exits. Also in the news: cybersecurity, ADHD drugs, and more.
