Wakely Wire
August 8, 2024
New Insights
Whitepapers, briefs, press releases and more
2022 RADV Results and Insights
Wakely conducts national HHS-RADV IVA surveys to assist participants in estimating their RADV-adjusted risk transfers months before CMS releases official results. Obtaining timely estimates of RADV impacts and detailed deliverables allow issuers to understand RADV impact to risk transfers and manage financial risks.
Medicaid Redetermination Impacts on the Individual Market
Following three years of Medicaid’s continuous coverage requirements, Congress passed legislation terminating this provision. The resumption of Medicaid redeterminations has implications not only for the Medicaid program but also the individual market. Currently, there is limited data on the claims experience for those individuals who transitioned between Medicaid and the individual market in 2023, posing ... Read more
Week in Washington 08/08/24
CMS Regulations CMS (finally) finalized a rule that will make it easier for CMS to approve breakthrough technology devices for Medicare coverage. CMS estimates that the rule will increase the number of national coverage determinations and expects to accept about 5 a year, there were no estimates on the effect of the rule change on ... Read more
Events & More
Unlocking Solutions in Medicaid, Medicare, and Marketplace
Curious about how healthcare can balance access and reimbursement for groundbreaking new therapies?
Join us at the Unlocking Solutions in Medicaid, Medicare, and Marketplace conference to explore this critical issue. Don’t miss the panel on Sickle Cell Treatment Innovation & Strategies to Improve Access, which will delve into transformative therapies for this challenging condition, and discussions on drug pricing and policy with State Medicaid directors and Health Plan executives.
Newsworthy Findings
Uninsured Rate Jumps to 8.2% Amid Medicaid Unwinding: CDC
Growth in the nation’s uninsured rate could become steeper if subsidies in the Affordable Care Act exchanges expire on schedule next year.
Appeals Court Hands Providers Latest Win in No Surprises Litigation
The 5th Circuit Court’s decision vacates instructions that arbiters should first consider the qualifying payment amount in deciding payments over contested out-of-network bills.
NAACOS Worries New ACO REACH Changes Could Force Exits
The Centers for Medicare & Medicaid Services (CMS) quietly released changes to the ACO REACH Model, prompting mixed reactions from the National Association of ACOs (NAACOS), which is still evaluating the impact of the modifications on its members.
Bipartisan Policy Center Urges Congress to Extend Medicare Hospital at Home, Telehealth Policies by End of Year
The Bipartisan Policy Center's report recommends that Congress reauthorize the pandemic-era Acute Hospital Care at Home waiver for five years to allow more hospitals and patients to benefit from the program.
Centene to Exit Medicare Advantage Market in 6 States
Actions won't impact Medicaid or ACA business in these states, where, notably, CVS and UnitedHealth Group both have presences, says Stephens report.
Bonus Article
Chinese Doctor Removes Patient’s Lung Tumor Using Robot from 3,000 Miles Away
Just for Fun
Math Riddle:
How do you keep warm in a cold room?
Prior Week
Q: I add six to eleven and get five. Why is this correct?
A: When it is 11 a.m., adding six hours makes it 5 p.m.
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