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Centers For Medicare And Medicaid Services

All articles tagged with #centers for medicare and medicaid services

health1 year ago

Court Ruling Prompts Medicare Advantage Star Rating Overhaul

A federal judge in Texas ruled in favor of UnitedHealth Group, stating that the Centers for Medicare and Medicaid Services (CMS) improperly included a disputed phone call in calculating UnitedHealth's Medicare Advantage star ratings. As a result, CMS must revise UnitedHealth's 2025 ratings by removing the call center metric and publish the updated ratings in the Medicare Plan Finder. This decision comes as UnitedHealth sought an expedited ruling to influence Medicare's open enrollment period, which ends on December 7.

via STAT|
#centers-for-medicare-and-medicaid-services#health#lawsuit
healthcare1 year ago

"Advancements in Sickle Cell Gene Therapies Offer Hope for Patients"

The U.S. government plans to implement an "access model" to help state Medicaid programs afford new gene therapies for sickle cell disease, which come with multimillion-dollar price tags. The Centers for Medicare and Medicaid Services will pursue outcomes-based agreements with drug manufacturers to negotiate pricing and rebates on behalf of participating states, starting in January 2025. This move aims to alleviate concerns over the financial burden of these curative treatments on Medicaid programs, which many people with sickle cell disease rely on for health care coverage.

via STAT|
#centers-for-medicare-and-medicaid-services#gene-therapies#healthcare
healthcare2 years ago

Biden's Medicaid Warning: Health Care Wins Under Threat

The Biden administration is pressuring states to meet federal requirements as they renew Medicaid coverage for millions of people, with concerns over high rates of coverage losses due to paperwork problems, long call center wait times, and slow application processing. The Centers for Medicare and Medicaid Services sent letters to all 50 states and Washington, D.C., identifying these concerns, with 36 states falling short on at least one criterion. The move towards transparency represents a shift in enforcement activities, as the agency faces pressure to take stronger action against noncompliant states. Over 4 million people have lost Medicaid benefits in the last four months, with the majority losing coverage due to paperwork issues.

via POLITICO|
#biden-administration#centers-for-medicare-and-medicaid-services#coverage-losses
healthcare2 years ago

Expanding Access to Healthy Food: Overcoming CMS Rules

Recent guidelines issued by the Centers for Medicare and Medicaid Services (CMS) are limiting the ability of "food as medicine" programs, such as produce prescriptions, to deploy interventions, refine delivery, and understand their impact. The guidelines restrict states using innovative Medicaid financing from enrolling members in food-as-medicine programs for more than six months, regardless of diagnosis or financial circumstance. This limitation undermines efforts to address diet-related chronic diseases, which account for a significant portion of healthcare costs, and hinders the ability to study the long-term health benefits of food-as-medicine interventions. Advocates are urging CMS to extend enrollment periods, convene a stakeholder task force, and review evidence to support the success of these programs.

via STAT|
#centers-for-medicare-and-medicaid-services#chronic-disease#food-as-medicine