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Week in Washington 10/17/24
A few bits of potpourri from this week – CMS Releases Additional ACA Information for 2026 Plan Year CMS released two items related to the 2026 plan year. It released the 2026 maximum out of pocket (MOOP) figure. For 2026 for self-only coverage the MOOP will be $10,150 or an increase of 10.3% relative to ... Read more
Events & More
Falling Stars: Who's Who in the 2025 Star Ratings
This webinar will cover the recently-released 2025 Star Ratings, including an analysis of the expected impact on 2025 Medicare payments. Attendees should expect to hear discussions of the latest performance and program changes, along with the resulting impact on the contract level star ratings. We’ll also dive into the dramatic increase in cutpoints and discuss what plans can expect over the next few years. Beyond cutpoints, we will cover other upcoming changes to the Star Rating program and discuss their potential impact on Medicare Advantage Organizations (MAO).
Newsworthy Findings
FTC Increases Premerger Reporting Requirements Over Provider Objections
Companies will be required to disclose information about minority investors and M&A activity going back five years. Provider groups said the new requirements would be burdensome.
Elevance Lowers Guidance on ‘Unprecedented’ Medicaid Challenges
Executives said the increased costs pressuring its Medicaid business would improve after states updated payment rates to better match member acuity.
Biden-Harris Administration Takes Groundbreaking Action to Expand Health Care Access by Covering Traditional Health Care Practices
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved section 1115 demonstration amendments that allow, for the first time ever, Medicaid and Children’s Health Insurance Program (CHIP) coverage of traditional health care practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations (UIO).
Medicare Advantage Star Ratings Fall Again in 2025
About 40% of MA plans with prescription drug coverage will earn four or more stars in 2025. This is a decline from this year, where 42% of MA plans with prescription drug coverage received four or more stars, and down from 51% in 2023 and 68% in 2022.
How Will Trump or Harris Approach AI Regulation as Future President?
AI regulation could see Kamala Harris continuing Biden's balanced approach, while Donald Trump may repeal current rules to encourage innovation.
Bonus Article
New Cervical Cancer Treatment Regime Shows ‘Biggest Gain in Survival Since 1999’
Just for Fun
Math Joke:
Why don’t circles ever argue with triangles?
Prior Week
Q: Do you know who invented algebra?
A: An x-pert
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