From Medicare Advantage News - After a surprising policy suspension that gave sanctioned plans like Cigna Corp. a break on their star quality ratings, CMS now is considering several adjustments to the star ratings program to account for sanctions and other actions, and floated three potential changes by attendees at its Medicare Advantage and Part D fall conference on Sept. 8. At the same time, the agency has made a series of tweaks to the Medicare Plan Finder (MPF) tool, highlighting which plans are under an enrollment sanction and adding more information about the sanction itself. Read more
From Health Plan Week - HHS’s proposed Notice of Benefit and Payment Parameters for 2018 (CMS-9934-P) could alter the way risk adjustment and other tenets of Affordable Care Act (ACA) exchanges work, but the provisions, unveiled Aug. 29 to keep carriers on the exchanges or bring back those that have left, failed to impress Wall Street or ease concerns of insurers. One major analyst even said the sheer complexity of the formulas used by HHS… Read more
From AIS's Value-Based Care News - Children’s National Health System realized it might encounter some roadblocks as it implemented medical homes — as an academic medical center, its systems had been set up in silos for the benefit of the faculty, residents, nurses and administration, not for patients and their families. Despite these obstacles, Children’s National’s patient-centered medical homes (PCMHs) are increasing utilization of primary care while simultaneously cutting emergency department visits. Read more
From Medicare Advantage News - In its second year of expansion under the Affordable Care Act, Kentucky’s Medicaid program saw significant increases in outpatient utilization and preventive care, reductions in emergency department use and improvements in health care quality and self-reported health, according to new research posted Aug. 8 to the JAMA Internal Medicine website. Yet a proposal presented in June by newly elected Gov. Read more
From Drug Benefit News - Beginning in 2018, prescription drug utilization data could be used to improve the predictive ability of the public health insurance exchanges’ risk-adjustment program, CMS said in its 294-page proposed Notice of Benefit and Payment Parameters (NBPP), which outlines payments and requirements for the 2017 benefit year. While CMS proposes several changes to the risk-adjustment methodology for health plans sold through public insurance exchanges, the inclusion of pharmacy data for 11… Read more
From Report on Medicare Compliance - Civil monetary penalties (CMPs) of all kinds are now higher — considerably in some cases — according to an HHS interim final rule published in the Federal Register Sept. 6. The CMPs are being updated for inflation as required by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 after no movement for almost 20 years. The update affects dozens of CMPs levied by CMS, the HHS Office of… Read more
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