ISPOR—The Professional Society for Health Economics and Outcomes Research的动态

https://lnkd.in/drXkBTiu The Centers for Medicare & Medicaid Services have finalized changes to Medicare Advantage plan capitation rates and Part C and Part D payment policies for 2025. These changes are expected to increase MA plan revenues by an average of 3.7% from 2024 to 2025. The notice includes adjustments to the Part C risk adjustment model, updates to Part C and D star ratings, stability adjustments for the MA program in Puerto Rico, and implementation of changes to the standard Part D drug benefit. CMS also encourages stakeholders to provide feedback through the Medicare Advantage Data Request for Information, with comments due by May 29. #MemberOutreach #MemberEngagement #MedicareCoverage #MedicareAdvantage #MedicarePlans #HealthcareBenefits #MedicareEnrollment #HealthcareAccess #MedicareServices #MemberSupport #Redetermination #MedicareAdvocacy #HealthcareNavigation #MedicareAssistance

https://lnkd.in/eiFUsj5N The Centers for Medicare & Medicaid Services have finalized changes to Medicare Advantage plan capitation rates and Part C and Part D payment policies for 2025. These changes are expected to increase MA plan revenues by an average of 3.7% from 2024 to 2025. The notice includes adjustments to the Part C risk adjustment model, updates to Part C and D star ratings, stability adjustments for the MA program in Puerto Rico, and implementation of changes to the standard Part D drug benefit. CMS also encourages stakeholders to provide feedback through the Medicare Advantage Data Request for Information, with comments due by May 29. #MemberOutreach #MemberEngagement #MedicareCoverage #MedicareAdvantage #MedicarePlans #HealthcareBenefits #MedicareEnrollment #HealthcareAccess #MedicareServices #MemberSupport #Redetermination #MedicareAdvocacy #HealthcareNavigation #MedicareAssistance

The Centers for Medicare & Medicaid Services (CMS) released draft guidelines of how it will approach the IRA for the medicines to be price-controlled in 2027, and the agency’s suggested rules raise more questions than they answer. CMS is still refusing to demand that PBMs ensure that savings are passed to patients, and plans for the administrative structure that will hold the whole program together financially – the Medicare Transaction Facilitator – still remain dangerously underdeveloped. Read more on their draft guidance here: https://lnkd.in/egmbvyb2

?? Major Updates for Medicare Advantage: D-SNPs & C-SNPs in 2025! The 2025 Annual Enrollment Period (AEP) is approaching, and there are significant changes coming to D-SNPs and C-SNPs that healthcare professionals and insurers need to be aware of. ?? This detailed article covers: ?? Key regulatory changes ?? How these updates impact plan offerings ?? Strategies to stay ahead in this evolving landscape If you’re working in the Medicare space, understanding these updates is crucial for optimizing your strategy in 2025! Follow Jared Strock for daily insights like this one! ?? Read more here: https://lnkd.in/eEZ2E5zx #MedicareAdvantage #DSNP #CSNP #AEP2025 #HealthcareMarketing #RegulatoryUpdates

What is the Medicare Shared Savings Program? Medicare Shared Savings Program (MSSP) is a program created by the Centers for Medicare & Medicaid Services (CMS) that promotes accountability among providers and reduces costs for beneficiaries. As part of the MSSP, providers are encouraged to form Accountable Care Organizations (ACOs) to provide high-quality coordinated care at a lower cost to Medicare beneficiaries. ACOs are groups of providers who work together to provide coordinated, high-quality care to Medicare patients. The MSSP provides incentives for ACOs that can reduce costs while maintaining or improving quality of care. ACOs must meet certain quality standards and share in the savings they achieve. If an ACO meets the required quality metrics and saves money, they will receive a portion of the savings. If an ACO does not meet the quality measures or fails to save money, they are not eligible to receive any shared savings. Need no cost help? Call Sheryl Gulan Lic #19582450

On June 28, the Centers for Medicare & Medicaid Services (CMS) announced a Proposed Rule titled Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023 (CMS-1799-P). While CMS touts this rule as a step forward in addressing billing abuses within the Medicare Shared Savings Program, it raises questions about the agency’s historical efficacy and commitment to combating fraud. The Shared Savings Program is designed to promote accountability for the healthcare of Medicare beneficiaries and encourage efficient service delivery. However, recent trends in billing activities, specifically concerning durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), have prompted concerns about the integrity of financial calculations. In the 2023 calendar year (CY), CMS observed a spike in billing for specific intermittent urinary catheter supplies, identified by HCPCS codes A4352 and A4353. This surge in billing could, if not addressed, distort the accuracy of expenditure and revenue calculations critical to the program.

What Are Medicare Dual Eligible Special Needs Programs? Dual Special Needs Plans (DSNPs) coordinate care for individuals eligible for both Medicare and Medicaid — otherwise known as dually eligible. Dual Special Needs Plans (DSNPs) are specific Medicare Advantage plans made for duals or dual eligibles. Due to the often-complex nature of social, mental and physical care needs for duals, DSNPs help centralize the care from the two programs and provide patient-focused care that is easier to navigate. Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individuals eligibility. Contact Janis Lakkees for all your Medicare needs in Upland, CA.

In case you missed it: On July 19, the Centers for Medicare & Medicaid Services (CMS) rolled out new rules to prevent unauthorized changes to consumers’ enrollments by agents and brokers. These changes aim to enhance the integrity of the Federally-facilitated Marketplace (FFM). Here's what you need to know: Key Updates: Agents assisting a consumer with a different broker of record will encounter an error message on the EDE platform. Two Ways to Resolve This: 1. Initiate a 3-way call with the marketplace and the client. 2. Have the consumer complete enrollment via an approved EDE consumer pathway. Here is What Not to Do: 1. Do not create new applications when encountering this error. 2. Do not attempt to complete applications via the consumer pathway. For more details, please read our blog: https://zurl.co/iBEl

Write ACA products? Check out the update below. ?? #ACA #HealthInsurance

The Centers for Medicare & Medicaid Services (CMS) have announced key changes for 2025. These updates, which affect Part D of the drug benefit program, are crucial for anyone involved with Medicaid, Medicare, and CHIP. To understand these regulatory requirements and their impact, head over to our blog for more details! https://bit.ly/3RJdbWF