CMS issued proposed changes to the way Medicare Advantage beneficiary risk is scored in 2019, which would incorporate mental health, substance abuse disorder and chronic kidney disease into the risk-adjustment model.
Payer
CMS approved its first 10-year Section 1115 Medicaid waiver Dec. 28, authorizing Mississippi to continue its family planning waiver through 2027.
Dayton, Ohio-based Premier Health and UnitedHealthcare agreed to a new, multiyear contract, effective Jan. 1.
Fishersville, Va.-based Augusta Health's in-network contract with Anthem expired Dec. 31, according to NBC 29.
Beneficiaries covered under Humana Tricare regained in-network access Jan. 1 to Birmingham, Ala.-based Brookwood Baptist Health's hospitals, outpatient centers and physician clinics, which are owned by Dallas-based Tenet Healthcare.
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CVS Health's $69 billion deal with Aetna is one way CVS responded to Walgreens' partnership with Prime Therapeutics — a partnership that makes it unlikely Walgreens will buy an insurance company in 2018, healthcare journalist Bruce Japsen wrote in Forbes.
Anthem Blue Cross Blue Shield plans to reduce payment by 25 percent for some separate services administered on the same day as a wellness exam or another procedure.
Fishersville, Va.-based Augusta Health's contract dispute with Anthem BlueCross BlueShield evoked discussions on possible legislative intervention, the NewsLeader reports.
Missouri Sen. Claire McCaskill, D, requested information regarding Anthem's decision to no longer cover emergency department care it deems nonemergent, the St. Louis Post-Dispatch reports.
Becker's Hospital Review reported these 92 contract resolutions and dissolutions between payers and providers this year, beginning with the most recent.