Wakely Wire
New Insights
Whitepapers, briefs, press releases and more
CDPS+Rx v7.1 Update Review
Risk adjustment is an important part of Medicaid Managed Care reimbursement. To help MCOs, states, providers, and other users of the UCSD models, this paper explores the changes from CDPS+Rx version 7.0 to version 7.1 and their impact on risk scores.
Week in Washington 11/14/24
Election Updates Republicans secured control of the House of Representative this week. This means Republicans have a trifecta and will be able to move legislation, especially via the reconciliation process. Republicans are expected to have a narrow House control, which could slow the passage of legislation. Also, this week Senate Republicans confirmed a new Senate ... Read more
Events & More
Wakely Webinar: Electoral Consequences: Impact on the ACA Marketplace
The 2024 elections could create dramatic changes in the ACA marketplace. Enhanced ACA subsidies passed during the pandemic are set to expire in 2025, and a new CMS administrator will shape policy and regulatory components that affect marketplace and consumer dynamics. This webinar is designed for health plans currently participating in the ACA marketplaces, plans who are considering attending, as well as state regulators and marketplace leaders who need to understand changes that might be coming their way. The webinar will cover not only what is expected to change (2026 Notice of Benefit and Payment Parameters, AVC) but also what could possibly change that will affect 2025 Marketplaces and beyond.
Newsworthy Findings
J&J Sues Federal Government for Halting 340B Rebate Plan
The New Jersey-based drugmaker is trying to get the courts’ backing to pay hospitals rebates for two drugs in the 340B drug discount program, instead of offering upfront discounts.
Aetna Launched a Copay-Only Health Plan. What Could it Mean for Benefits Teams?
The plan requires only copays for medical services and prescription drugs up to the plan member’s out-of-pocket maximum, with no deductibles or coinsurance costs.
With ACA Subsidies Set To Expire In 2025, Millions of Americans stand to lose health insurance
With Republicans edging closer to gaining control of Congress, millions of Americans may be at risk of losing enhanced subsidies that currently underwrite the cost of health insurance bought through the Affordable Care Act's marketplaces, according to industry experts and the Congressional Budget Office.
KFF Health News Sues To Force Disclosure of Medicare Advantage Audit Records
KFF Health News has sued the U.S. Department of Health and Human Services Office of Inspector General to compel it to release a range of Medicare Advantage health plan audits and other financial records.
Pharmacy Costs, High Utilization Drive Kaiser to $608M Operating Loss in Q3
Kaiser Permanente said on Friday it will attempt to cut administrative costs after the system recorded a $608 million operating loss during the third quarter, compared with a $156 million gain in the previous year.
Bonus Article
World’s First Wooden Satellite Aims to Tackle Space Debris Problem with Sustainable Solution
Just for Fun
Math Joke:
Why is it a good idea to bring a mathematician camping?
Prior Week
Q: Why did the obtuse angle go to therapy?
A: Because it was never right!
Sign up for the
Wakely Wire,
our industry newsletter.
