 Health Care |
Health Care |
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Regulators crack down on Medicare Advantage charges
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The Centers for Medicare and Medicaid Services (CMS) has finalized plans to reduce overpayments to Medicare Advantage insurers after a monthslong lobbying campaign from the industry opposing the changes. |
© AP Photo/Pablo Martinez Monsivais, File |
Under the complex changes, set to roll out over the course of the next three years, CMS will enact what it calls "commonsense updates" to its payment model. This will include transitioning to using diagnosis codes that align with the rest of the health care system and implementing new data, which the agency says is more accurate at predicting health care costs. CMS pays private contracted insurers, known as Medicare Advantage Organizations (MAO), to provide Medicare services to their customers. These groups receive a set rate per beneficiary every year based on how likely they are to use health care services. The more diagnoses a patient has, the higher the risk is assumed and the higher the payments to the organization for that individual. MAOs have been criticized in the past for "upcoding" their patients, making them seem sicker on paper than they actually are by obtaining more diagnoses of conditions and thus more payments from the federal government. CMS will be removing 2,000 diagnosis codes, which the agency says are no longer related to conditions for which Medicare costs can be predicted. The health insurance industry has lobbied against these changes, running ad campaigns claiming the federal government is cutting Medicare funding. Federal contracts account for large portions of these companies' revenue and the proposed changes represent billions in reduced payments. |
Welcome to The Hill's Health Care newsletter, we're Nathaniel Weixel and Joseph Choi — every week we follow the latest moves on how Washington impacts your health. | |
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How policy will be impacting the health care sector this week and beyond: |
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Monthly ObamaCare premiums rose in 2023 for the first time since 2019, driven by inflation and increased health spending, according to a new analysis. Despite continued growth in the number of insurers offering plans, the monthly premiums for Affordable Care Act (ACA) benchmark plans increased by an average 3.4 percent between 2022 and 2023, according to the analysis by the Urban Institute and Robert Wood Johnson Foundation. … |
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| The World Health Organization (WHO) released new findings Monday that show that infertility affects one in six people globally. The report found that about 17.5 percent – or one in six people – of the adult world population are affected by infertility, which the organization defines as “failing to become pregnant after more than a year of unprotected sex.” The results also showed that there is little … |
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| New Jersey Gov. Phil Murphy (D) on Tuesday signed an executive order establishing the state as a safe haven for transgender young Americans and their families. Murphy's executive order, which is effective immediately, prevents individuals in New Jersey from being extradited to another state for providing, receiving or "otherwise facilitating" gender-affirming health care services that are legal in the state. The order additionally … |
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Branch out with a different read from The Hill: |
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Here are the best and worst states for gun safety |
Story at a glance The Giffords Law Center produces an annual scorecard grading states on their gun laws. California and New Jersey earned the highest grades for gun safety in the latest ranking. Arkansas, Wyoming and Idaho received the lowest. California ranks highest for gun safety among the states, while Arkansas ranks the lowest, according … |
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Local and state headlines on health care: |
- Kansas Legislature sends 'born alive' abortion bill to Kelly's desk with veto-proof majority (Kansas City Star)
- WA stockpiles abortion pills ahead of federal court ruling (Seattle Times)
- Public health physician named interim Virginia health commissioner (Washington Post)
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Health news we've flagged from other outlets: |
- Xanax and Adderall access is being blocked by secret drug limits (Bloomberg)
- To build trust among LA's unhoused, a street medicine team turns to technology (Stat)
- Recovery high schools help kids heal from an addiction and build a future (NPR)
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Most read stories on The Hill right now: |
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When it comes to water and Lake Mead every little bit helps. Read more |
| Former President Trump officially became the first former commander-in-chief to be charged with a crime on Tuesday. The global spotlight was on the … Read more |
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You're all caught up. See you tomorrow! |
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