Medicare & Medicaid
It would require MA plans to reimburse for items and services at least what would have been paid under original Medicare.
The pledge is part of a recent series of commitments made by health plans to overhaul prior authorizations.
Ninety percent of beneficiaries lived in a county where at least 50% were in plans sponsored by one or two insurers in 2024.
While the original lawsuit honed in on cut points, the new complaint focuses primarily on customer service phone calls placed by CMS.
This results from a decrease in direct spending of $1.1 trillion and a decrease in revenues of $4.5 trillion, CBO says.
CMS said it’s taking action to end the duplicate enrollments, saying it could potentially save taxpayers about $14 billion annually.
The court said Humana didn’t exhaust the administrative appeals process, though CMS has already rejected one appeal.
The AGs said a rule targeting 'improper' enrollments would cause widespread loss of insurance coverage and increase premiums.
The bill would double the federal investment in rural health care while reversing future changes to Medicaid hospital funding.
The agency is also proposing to phase out the Inpatient Only list (IPO) over a three-year period.