The policy analysis and guidance you need by the experts you trust, daily.
- After Hours
- Agent Oversight
- Brain Food
- Health Insurance Exchanges
- Part D
- Performance Optimization
- Policy & Health Reform
- Prospective Evaluations
- Provider Relations
- Risk Adjustment
- Sales & Marketing
- Star Ratings
- Alan Mittermaier on MA and Part D Proposed Rule Increases Plan Flexibility, Reduces Regulatory Burden
- Sharon Willliams on A New Source of Capital for Star Ratings and Clinical Innovations
- William on Will Trump and Price Pull Out the Scalpels for Star Ratings?
- Bobby on January Release of the Draft MMG – Perfect Timing
- Pam Lassila on Best Practices and Common Conditions of Audit Preparation
Topic: Policy & Health Reform
With the tax reform bill just the tip of the iceberg, Congress faces a daunting agenda for the remainder of the year. Below are some healthcare-related agenda items Congress will need to take up in the next few weeks.
No, the Reagan administration hasn’t come back, but things are looking up in our corner of the world. The Centers for Medicare & Medicaid Services (CMS) is a big ship, and it takes awhile to turn it around after a presidential transition. It is becoming clear the direction will continue to be towards value, but the path is shifting. The government needs to reduce the spend on healthcare, and reducing benefits and restricting eligibility aren’t going to fly on the Medicare side, so we have to get more bang for the buck.
Among multiple policy changes to the 2018 Prescription Drug Benefit Program proposed, the Centers for Medicare & Medicaid Services (CMS) would revise existing policy related to tiering exceptions, including the permissible limitations Part D plan sponsors may apply to tiering exception requests. CMS is proposing to eliminate the provision allowing plans to exclude a dedicated generic tier from the tiering exceptions process and establish a framework based on the type of drug (brand, generic, biological product) requested and the cost-sharing of applicable alternative drugs. CMS is also proposing to clarify appropriate cost-sharing for approved requests when alternatives are on multiple lower tiers and to codify that authorized generic drugs should be treated as generics for purposes of tiering exceptions.
The Centers for Medicare & Medicaid Services (CMS) recently released the highly anticipated Medicare Advantage (MA) and Prescription Drug Benefit Program (Part D) Proposed Rule for 2019. A big focus of the proposed regulation included increasing plan flexibility and reducing regulatory burden. Comments on the proposed rule are due to CMS by January 16, 2018.
As CMS Administrator Verma Announces Obama-Era Medicaid Policy Reversals, States Signal Support for Medicaid Expansion
Tuesday was a big day for Medicaid policy, with both a rollback of Obama Era policy reversals and a movement toward more states adopting Obamacare’s Medicaid Expansion.
With two months of Affordable Care Act (ACA) stabilization bill efforts under the belt, it is becoming questionable whether Congress will be able to pass, or even bring to the floor, a bill President Trump will support and sign. We saw some developments this week that may shape the future of cost sharing subsidy payments as well as any other ACA fixes in the months to come.
Congress moved beyond considering the Affordable Care Act (ACA). From potential changes to the Medicare Advantage (MA) program to necessary extensions of already existing Medicare programs, Congress had a busy working week moving the healthcare agenda.