Medicare Advantage and Part D
Medicaid Plan Exits May Disrupt Enrollees, but Not Care QualityFrom Medicare Advantage News - Medicaid enrollees and states may experience some temporary turbulence when managed care organizations choose to leave a state, but a new study finds that plan exits do not create significant changes in market-level quality or self-reported patient experience. Read more
Wash. Awards Regional Contracts To Integrate Behavioral CareFrom Medicare Advantage News - As part of an ongoing effort to regionalize Medicaid purchasing and provide Apple Health Medicaid beneficiaries with the full continuum of physical and behavioral health services through managed care by 2020, the Washington state Health Care Authority (HCA) has notified subsidiaries of Anthem, Inc., Centene Corp. and Molina Healthcare, Inc. of its intent to award Fully Integrated Managed Care (FIMC) contracts in the North Central Region. The new FIMC program… Read more
More Formularies May Mean More Problems on Audits, Suggests CMS (with Table: MA and Part D Sponsors Receiving a…From Medicare Advantage News - CMS’s annual report summarizing activities for the prior audit year — released several months earlier than usual — contained some “encouraging” results, such as improved performance in the Part D program areas of Formulary and Benefit Administration (FA) and Coverage Determinations, Appeals, and Grievances (CDAG), observed a CMS official who spoke during a May 11 session of the Medicare Advantage and Prescription Drug Plan Audit and Enforcement Conference. Read more
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Medicare Advantage & Part D Blog
By Lauren Flynn Kelly
- June 29, 2017
In writing the latest issue of Medicare Advantage News, which was made more difficult by late-breaking developments in the Senate’s effort to repeal and replace the Affordable Care Act, I was struck by how sensitive the issue of delivering health care is. At the end of the day, it’s about meeting...
By Lauren Flynn Kelly
- May 25, 2017
In the 2018 final payment notice and Call Letter issued last month, CMS threw in an unusual request for information (RFI) soliciting ideas on ways it can bring more transparency, flexibility, program simplification and innovation to the Medicare Advantage and Part D programs. The agency has...
By Lauren Flynn Kelly
- February 3, 2017
Fulfilling a new statutory requirement, CMS on Feb. 1 released its annual Advance Notice and draft Call Letter for Medicare Advantage and Part D plans 60 days prior to the final notice — about two weeks earlier than usual. This theoretically gives plans more time to prepare bids due in June,...
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