Wakely Wire
New Insights
Whitepapers, briefs, press releases and more
Summary of CY2026 Final Rate Announcement & CY2026 Final Part D Redesign Instructions
The Centers for Medicare & Medicaid Services (CMS) recently released the Announcement of Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, which finalizes important changes in plan payments, risk adjustment and other financial and regulatory requirements for 2026. In tandem, CMS released the ‘Final CY 2026 ... Read more
Final 2026 HHS HCC Risk Adjustment Model Impact Estimates
In this paper, we analyze the impact of risk adjustment model changes from the final 2026 HHS HCC risk adjustment model based on 2024 data collected through the WNRAR project. We scored data with the final 2024, final 2025, and final 2026 HHS HCC risk adjustment models and summarized the impact to risk scores and ... Read more
Week in Washington 04/17/25
Prescription Drug Tariffs A notice was published in the Federal Register that effectively is a precursor to the Administration applying tariffs on imported drugs. The review includes not just the drugs but also components such as active pharmaceutical ingredients and key starting material (i.e., potential for a very broad tariff). Feedback is due in 21 ... Read more
Events & More
PACE - Part D Funding
This webinar will be focused on changes to Medicare Part D, highlighting where responsibility has shifted from CMS to the Medicare plans and PACE organizations in the catastrophic phase of coverage.
Newsworthy Findings
HHS Layoffs May be Illegal, Legal Experts Say
The federal health department sidestepped normal reduction-in-force procedures this month as it laid off 10,000 employees, according to sources. One union has already filed an internal complaint.
Trump Signals Plan to Address ‘Pill Penalty’ of Drug Pricing Law
The president’s executive order promising to lower pharmaceutical prices includes support for a fix long sought by the industry, and could augur a new push for Medicare site neutrality.
Medicare Proposes 2.4% Pay Hike for Inpatient Hospitals Next Year
The rate increase is the lowest since 2019. The American Hospital Association slammed it as inadequate.
US Launches Probe That Could Set Stage for Pharma Tariffs
The Commerce Department has begun a so-called Section 232 investigation into the national security effects of the U.S. importing pharmaceuticals and their starting materials.
CMS Rejects Humana’s Medicare Advantage Star Ratings Appeal
The CMS has denied Humana’s internal appeal to improve the insurer’s Medicare Advantage bonus ratings, Humana disclosed in a filing on Tuesday in its ongoing litigation against the government for allegedly arbitrarily calculating the scores.
Bonus Article
Teens Developed App That Identifies Mouth Cancer–Making Early Diagnosis Easy and Winning $50k for Their School
Just for Fun
Math Joke
If seven people meet each other and each shake hands only once with each of the others, how many handshakes happened?
Prior Week
Q: Why was the equal sign so humble?
A: Because it knew it wasn’t less than or greater than anyone else.
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