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Medicare and inflation

| Apr 18, 2022 | Federal

Medicare Advantage in 2022

| Mar 1, 2022 | Federal

Medicare-directed managed care has come a long way in four decades. What began in 1985 as a limited option available only in select markets—it was initially known as “HMO risk contracting”—has evolved into Medicare Advantage (MA), which is a major book of business for much of the private health insurance...[ Read More ]

Background on CMMI’s Direct Contracting Model

| Feb 18, 2022 | Federal

The Biden administration has come under pressure in recent weeks to modify, or even pull back entirely, the Center for Medicare and Medicaid Innovation’s Direct Contracting Model, which was originally developed during the Trump era. (The administration has indicated it will announce its plans for the model “soon”.) The following...[ Read More ]

The CMS-Georgia waiver battle

| Jan 28, 2022 | Federal

Georgia Gov. Brian Kemp has been engaged in a multi-year back-and-forth with federal officials over the state’s Medicaid and insurance market waiver programs, as reflected in the following timeline of the most notable steps taken by both sides. A final resolution of the standoff is not yet in sight, or...[ Read More ]

Medicaid’s budget neutrality rules for section 1115 waivers

| Jan 18, 2022 | Federal

For decades, a focus in Medicaid has been on state proposals that fall outside what is allowable under the program’s normal rules. The Secretary of Health and Human Services (HHS) has wide discretion under section 1115 of the Social Security Act to “waive” legal or regulatory impediments to state initiatives...[ Read More ]

The status of federal price transparency requirements

| Dec 28, 2021 | Federal

The health sector has long resisted revealing the prices it charges payers and consumers, but bipartisan pressure from Washington is forcing it to change. New rules are beginning to take effect, or will in the coming years, which will push into the public domain a flood of pricing data. The...[ Read More ]

The 2020 national health expenditures report

| Dec 16, 2021 | Federal

The COVID-19 pandemic has been a transformative global event with far-reaching effects that are still unfolding. The recent annual report on national health spending from the Office of the Actuary’s National Health Expenditures Accounts Team in the Centers for Medicare and Medicaid Services (CMS) documents some of the dramatic shifts...[ Read More ]