Wakely Wire
January 31, 2025
New Insights
Whitepapers, briefs, press releases and more
Summary & Impacts of 2026 Medicare Advantage Advance Notice
The Centers for Medicare & Medicaid Services (CMS) recently released the 2026 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C/D Payment Policies, which proposes important changes in plan payments, risk adjustment and other financial and regulatory requirements for 2026. Wakely summarizes key changes that will affect Medicare Advantage pricing for ... Read more
Concentration of Specialty Services in Medicaid Provider Networks
Medicaid consumers, providers, managed care organizations, and states all have an interest in ensuring access to specialty care for Medicaid beneficiaries. We sought to interrogate the national Transformed Medicaid Statistical Information System (TMSIS) database to learn more about specialty provider networks and examine the provision of specialty services across various states. The concentration of specialty ... Read more
Week in Washington 1/30/25
Budget Freeze Confusion This week health policy news was dominated by the Trump Administration instituting funding freeze on financial assistance. Early in the week the White House announced, via a memo, a freeze in financial assistance programs, including grants and loans. This resulted in a wide freeze in federal funds including states being unable to ... Read more
Newsworthy Findings
White House Rescinds Memo Pausing Federal Funding Following Pushback
The Office of Management and Budget canceled a memo pausing federal funding that caused widespread confusion and alarm this week.
CMS Withdraws Appeal of UnitedHealth's Star Ratings Lawsuit
CMS has withdrawn its notice of appeal without providing an explanation for the change.
Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023
Virtually all enrollees in Medicare Advantage (99%) are required to obtain prior authorization for some services – most commonly, higher cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy.
Medicare Advantage Members Gain Access to Innovative Digital Therapeutics Through New Partnership
Medicare Advantage members in Massachusetts and Arizona now have a powerful new resource to help manage pain and physical function, thanks to a unique partnership between eternalHealth and Kaia Health. This collaboration brings clinically validated, low cost digital therapy to Medicare Advantage members, empowering them to take control of their health from the comfort of their homes.
Main Line Health Threatens to Go Out of Network with Cigna Over Contract Dispute
Main Line Health says Cigna hasn’t updated its reimbursement rate since 2016, however Cigna says it is negotiating in good faith to find a solution that keeps healthcare affordable for patients.
Bonus Article
Carrots May Be Key to Unlocking Microbiome’s Diabetes Defense System
Just for Fun
Math Joke:
What do you call a number that just can’t stand still?
Prior Week
Q: Why did the student eat his math homework?
A: Because his teacher said it was a piece of cake
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