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Following NYT Investigation, AHA Urges DOL to Investigate Actions of MultiPlan and Commercial Insurers
The American Hospital Association (AHA) writes regarding a recent The New York Times investigation into the disturbing incentives for data analytics firm, MultiPlan, and large commercial insurers like UnitedHealthcare, Aetna and Cigna, to cut reimbursement rates for care provided to employees of companies with self-funded employer insurance plans and increase costs for patients receiving that care.
CMS Issues Final Notice of Benefit and Payment Parameters for 2025
The Centers for Medicare & Medicaid Services (CMS) April 2 released its standards for qualified health plans (QHPs) offered through the health insurance marketplaces for 2025. Beginning in plan year 2025.
Administration Finalizes Limit on Short-term, Limited-duration Health Insurance
The Departments of Health and Human Services, Labor and Treasury releases final rule limiting the sale of non-comprehensive health care coverage and promoting greater consumer understanding of their coverage options.
AHA Response to Employee Retirement Income Security Act (ERISA) RFI
Health insurers have gone through dramatic vertical consolidation since ERISA was signed into law. Over the last decade, the major corporate insurers have spent billions of dollars acquiring not only other plans, but also providers, pharmacy service companies, and health technology and claims adjudication systems.
CMS Issues Proposed Rule for CY 2025 Medicare Advantage, Prescription Drug Plans
The Centers for Medicare & Medicaid Services (CMS) Nov. 6 released its proposed Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, and Health Information Technology Standards for Contract Year (CY) 2025 (CMS-4205-P).
AHA Urges CMS to Swiftly Correct Medicare Advantage Plan Policies That Appear to Violate CY 2024 Rule
The American Hospital Association is deeply concerned that these practices will result in the maintenance of the status quo where MAOs apply their own coverage criteria that is more restrictive than Traditional Medicare proliferating the very behavior that CMS sought to address in the final rule, resulting in inappropriate denials of medically necessary care and disparities in coverage between beneficiaries in MA and those in the Traditional Medicare program.
AHA Urges MedPAC to Examine Medicare Advantage Denials, Hospital Market Basket
We appreciate the Medicare Payment Advisory Commission’s (MedPAC) November meeting discussions on Medicare Advantage (MA) prior authorization and network management. As MedPAC begins its discussions on payment adequacy for the Medicare program, we outline concerns about the impact that the shifting labor force and costs have had on hospitals and health systems, including whether the current market basket methodology is adequate to capture these changes.
AHA Comments on CMS’ Proposed Medicare Advantage Policies for 2025
AHA comments on the CMS proposed rule for policy and technical changes to the Medicare Advantage program in contract year 2025.
CMS Issues Frequently Asked Questions Related to CY 2024 Medicare Advantage Final Rule
The CMS Feb. 6 released a Frequently Asked Questions document pursuant to the calendar year 2024 Medicare Advantage final rule, which went into effect Jan. 1.
Release 2024.2 Create Landing Pag eTest
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