Payer executives are expecting to lose members in their Medicaid managed care contracts as states begin the redetermination process, but some are hopeful to convert some of these members to other lines of business. 

As Medicare Advantage insurance companies continue to grow in popularity, it’s important for our nation’s health policy leaders to ensure that MA enrollees have access to the same level of medically-necessary coverage as traditional Medicare. Fortunately, CMS has proposed a rule to address this problem, and public comments are due Feb. 13.

Payer executives are still taking stock of tougher Medicare Advantage auditing standards CMS unveiled Jan. 31.  

A federal judge in Texas has handed another win to the Texas Medical Association and medical providers nationwide against HHS over a challenge to the arbitration process between out-of-network providers and payers that was established under the No Surprises Act.

Proposed Medicare Advantage plan rates introduced by CMS could have some impacts on revenue, but it's too early to see the full scope, Cigna CEO David Cordani told investors on a Feb. 3 call transcribed by Seeking Alpha. 

CMS is looking to create a "universal foundation" of quality measures across all its programs, such as Medicare and Medicaid.

CMS is expecting a small revenue bump of 1.03 percent on average for Medicare Advantage and Part D plans in 2024 as part of a slate of potential risk adjustment and star ratings changes that has some industry leaders concerned. 

CMS' new Medicare Advantage auditing standards did not include enough information about auditing methods to understand its full impacts, Humana executives said on a Feb. 1 investor call. 

CMS will implement stricter audits of Medicare Advantage plans, a move that could leave payers on the hook for billions of dollars in repayments to the federal government. 

HHS is proposing a new pathway for no-cost contraceptive coverage for employees of organizations with religious objections to covering these services. 

 A proposed rule change coming from CMS is making payers nervous. 

The nation's largest insurers are gearing up for upcoming changes to Medicare Advantage risk adjustment rules that could collectively cost them up to $3 billion in returned payments, with Humana potentially facing the biggest penalties, Bloomberg reported Jan. 24.

The Blue Cross Blue Shield Association has released a set of policy proposals it says will reduce U.S. healthcare costs by $767 billion over 10 years.

AHIP is focused on Medicaid redeterminations and promoting competition in the marketplace for 2023. 

Over 700,000 providers and organizations are participating in one of CMS' three accountable-care programs in 2023, the agency said Jan. 17. 

Though negotiated prices won't appear until 2026, CMS is starting to implement the first-ever negotiated prices for drugs paid for by Medicare. 

HHS has extended the COVID-19 public health emergency until April 11.

CMS needs better strategies to ensure proper oversight of Medicare Part B drug payment calculations, according to a Dec. 3 report from HHS' Office of the Inspector General.

New Jersey has become the eighth state to require state-regulated health plans to cover abortion services.

New Mexico is planning several changes to its Medicaid program, focused on equity and whole-person care.