On June 12, a Maryland federal judge vacated parts of CMS’ rule designed to govern marketplace integrity and affordability.   The excised provisions include the $5 premium penalty on automatic re-enrollees, revocations of guaranteed insurance for people with past-due premiums, eligibility…

States have begun receiving payments from CVS Pharmacy’s $36.5 million settlement over allegations that the company overbilled Medicaid programs for insulin prescriptions between 2010 and 2020.  According to federal and state investigators, CVS dispensed more insulin pen cartons than prescriptions…

Health Care Service Corp. will launch a new line of commercial health plans called Edge across all five of its Blue Cross Blue Shield states beginning in 2027. The plans, powered by a proprietary plan design called Easify, have no…

In fiscal year 2024, Medicare Advantage patients remained in the hospital 11.2% longer on average than those in traditional Medicare, according to a June 15 report from the Medicare Payment Advisory Commission. MedPAC advises Congress on the Medicare program. Its…

Two June 8 reports from the HHS Office of Inspector General highlighted post-acute care denials and overturned appeals from Medicare Advantage organizations. Both reports focused on June 2024, looking across 19 MA organizations. The first report found the three largest…

The Centers for Medicare & Medicaid Services has established a new Office of Health Technology and Products to oversee healthcare technology modernization, digital products and platform transformation across the agency’s programs. The organizational change was approved by HHS Secretary Robert…

CMS elevated Clover Health’s Medicare Advantage star rating from 3.5 to 4.5 for its largest contract, according to a June 9 regulatory filing. Clover’s PPO covers 97% of its members, and the litigation did not include Clover’s HMO contract, which…

CMS issued guidance June 11 outlining plans to update its assessment of Medicaid section 1115 demonstration projects. Section 1115 demonstration projects allow states to test approaches for delivering and paying for Medicaid care. The June guidance stems from an HR…

Iowa’s state auditor, Rob Sand, released a report raising concerns about how pharmacy benefit managers handled prescription drug payments within Iowa Medicaid and whether the state had sufficient access to information to oversee those arrangements. The June 10 report found…

The U.S. Office of Personnel Management issued a letter June 10 to Federal Employees Health Benefits and Postal Service Health Benefits carriers on fraud, waste and abuse compliance requirements. The letter reiterates expectations of carriers, the office said. Robust FWA efforts…