Medicare Advantage and Part D

From Medicare Advantage News - Trade associations representing Medicare Advantage plans serving disadvantaged populations expressed numerous reservations about the two options CMS last month requested comments on for offering interim relief on star quality ratings for such plans (MAN 12/3/15, p. 1). In their comment letters filed by the Dec. 10 CMS deadline, the associations all thanked CMS for seeking ways to help these financially ailing plan sponsors in the short run, but said they had numerous questions remaining even after a Dec. 3 one-hour CMS conference call on the two options. And they generally voiced doubts about how effective either option would be in… Read more

From Medicare Advantage News - In what may be a cautionary tale amid the push to shift risk to providers in Medicare Advantage contracting in areas not used to it, 10,000-member Touchstone Health HMO will close at the end of this year. The White Plains, N.Y.-based MA plan has struggled financially, as have several larger New York MA sponsors recently, resulting in losses of network providers and members coupled with low albeit improving star quality… Read more

Medicare Advantage & Part D Blog

By James Gutman - January 29, 2016
Are you ready for another round of efforts to stop alleged abuse of home health risk assessments (HRAs) for diagnosis and payment purposes in Medicare Advantage (MA)? Well, ready or not, it is coming this year — and from multiple directions. And the chances of something getting done this year are...
By James Gutman - January 13, 2016
California would not have lacked legally sufficient reasons had it decided to stop participating in the CMS-backed demonstration for integrating care of Medicare-Medicaid dual eligibles at the end of 2016. By virtually any measure, the demo is not yet saving money for the state, and a 2013...
By James Gutman - January 6, 2016
About a year before the end of a presidential administration of either party, it seems, top regulatory officials in that administration realize they’re almost out of time to implement longstanding policy goals. So what follows is frequently an acceleration of pace in pursuing items that may have...

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