CMS is terminating its Medicare Advantage contract with American Health Plan of Texas after the insurer failed to meet minimum quality standards for three consecutive years. The agency issued a notice of termination Dec. 17 to the Franklin, Tenn.-based company,…
Medicare Advantage
Facing a shifting regulatory landscape and provider tensions, some insurers have reached a crossroads with Medicare Advantage. This year proved pivotal in shaping how payers would move forward. Here are the 3 biggest trends from the year: 1. Coding intensity…
CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo. After the pilot, the agency expects to expand the data-collection efforts to all…
Humana’s Louisiana business received at least $10.5 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit report from HHS’ Office of Inspector General. The audit, published in December, reviewed high-risk diagnosis codes including acute stroke, acute…
Clever Care Health Plan is pairing its culturally competent care model with a new provider network partnership built around the lifestyle habits of the world’s longest-living populations. The partnership launches in 2026 and will connect Clever Care’s 40,000 Medicare Advantage…
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CMS’s proposed Medicare Advantage rule for 2027 includes more leeway for hemp coverage. Hemp has low concentrations of tetrahydrocannabinol, as defined by the Agriculture Improvement Act of 2018. Under the proposal, hulled hemp seed, hemp seed protein powder and hemp…
CMS is reminding state insurance departments that federal law preempts any efforts to regulate Medicare Advantage broker compensation and marketing practices. The Dec. 4 memo obtained by Becker’s comes as UnitedHealthcare is suing the director of the Idaho Department of…
UnitedHealth Group is seeking to dismiss a lawsuit filed by Johnson City, Tenn.-based Ballad Health over alleged “Medicare Advantage manipulation,” arguing the health system is bound by arbitration agreements and filed the case to generate publicity. In a Dec. 4…
UnitedHealthcare has filed a lawsuit against the director of the Idaho Department of Insurance, arguing that the state’s recent efforts to regulate Medicare Advantage plan marketing and broker commissions are in violation of the U.S. Constitution. The lawsuit, filed Nov.…
CMS published its 2027 Medicare Advantage and Part D proposed rule on Nov. 25 that includes an overhaul of how star ratings are calculated, new enrollment flexibilities, and rollbacks of Biden-era health equity requirements. The proposed rule is subject to…