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The healthcare giant cut its guidance for 2024 yet again

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released two final regulations that added new requirements for states when operating their Medicaid programs.

The Final Rule gives CMS additional grounds on which to deny PACE organizations’ initial and service area expansion applications, imposes immunization requirements on staff who have direct contact with PACE participants, establishes deadlines for reviewing recommendations and scheduling services for PACE participants, and alters the grievance resolution process.

It is CVS Health's only ACO REACH partnership in the state, helping advance health equity issues and address social determinants of health

Collaboration across CMS centers and with ACO participants is key.

Few surprises or material changes from the advanced notice. Plans may see wildly different impacts based on their population and programs.

This new guidance has implications for Medicare Advantage stakeholders as a whole and for MAOs that seek to participate in the VBID program in the future.

No prior study has examined clinical quality of care for dually eligible individuals across D-SNPs, non–D-SNP MA plans, FFS Medicare with a stand-alone prescription drug plan.

Health plans and providers alike are disgruntled with a new report to Congress released by the Medicare Payment Advisory Commission (MedPAC).

Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023.

A provision in the Inflation Reduction Act will implement a $2000 out-of-pocket cap on Medicare beneficiaries’ prescription drug spending, which could save money for more than one million enrollees when it takes effect next year.

The rule implements changes to the Medicare Advantage RADV program, which CMS uses to recover improper risk adjustment payments made to Medicare Advantage plans.