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Farm Bureau Plans Offer Cheaper ACA Alternative with Trade-Offs

Farm Bureau Plans Offer Cheaper ACA Alternative with Trade-Offs

Farm bureau plans are emerging as a less expensive alternative to Affordable Care Act (ACA) coverage, offering lower premiums but with significant trade-offs. These plans, which are not subject to ACA regulations, may exclude coverage for pre-existing conditions and essential health benefits. While they provide a more affordable option for some consumers, they also pose risks due to their limited coverage. The Centers for Medicare and Medicaid Services have proposed expanding insurer prior authorization requirements to prescription drugs, aiming to improve transparency and timeliness in healthcare coverage.

Fresenius Kabi Receives CMS Approval for COVID-19 Specific HCPCS Codes for Tyenne

Fresenius Kabi Receives CMS Approval for COVID-19 Specific HCPCS Codes for Tyenne

Fresenius Kabi Receives CMS Approval for COVID-19 Specific HCPCS Codes for Tyenne

CMS Announces Medicaid Funding Cuts Affecting Thousands of Noncitizens

CMS Announces Medicaid Funding Cuts Affecting Thousands of Noncitizens

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance that will result in thousands of people losing federally funded Medicaid or Children's Health Insurance Program (CHIP) coverage later this year. This change is part of a law passed in 2025 that restricts federal funding for certain noncitizens. The updated policy allows states to claim federal matching funds only for U.S. citizens, nationals, lawful permanent residents, certain Cuban and Haitian entrants, and migrants lawfully residing in the U.S. under the Compacts of Free Association. The new rules are set to take effect on October 1, requiring states to update eligibility systems and notify affected enrollees.

CMS Issues New HCPCS Codes for Fresenius Kabi's COVID-19 Treatment Tyenne

CMS Issues New HCPCS Codes for Fresenius Kabi's COVID-19 Treatment Tyenne

The Centers for Medicare & Medicaid Services (CMS) has granted new Healthcare Common Procedure Coding System (HCPCS) codes for Tyenne, a tocilizumab biosimilar used in the treatment of COVID-19. These codes, effective from April 1, 2026, will facilitate billing and reimbursement for Tyenne when used in hospitalized adult patients receiving systemic corticosteroids and requiring supplemental oxygen or mechanical ventilation. Fresenius Kabi, the manufacturer, emphasizes that these codes will streamline claims processing and improve access to this treatment option.

CMS Announces Medicaid and CHIP Funding Cuts Affecting Thousands

CMS Announces Medicaid and CHIP Funding Cuts Affecting Thousands

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance that will result in thousands of individuals losing federally funded Medicaid and Children's Health Insurance Program (CHIP) coverage. This change is part of the Working Families Tax Cut legislation passed in 2025, which restricts federal funding for certain noncitizens. The guidance specifies that federal matching funds will only be available for U.S. citizens, lawful permanent residents, and certain other groups. States must update their eligibility systems by October 1 to comply with the new rules, potentially leaving many without coverage unless states choose to provide state-funded alternatives.

CMS Proposes 2.4% Hospital Pay Increase and Nationwide Payment Model Rollout

CMS Proposes 2.4% Hospital Pay Increase and Nationwide Payment Model Rollout

The Centers for Medicare & Medicaid Services (CMS) has proposed a 2.4% increase in payment rates for inpatient services for fiscal year 2027. This proposal includes the first mandatory nationwide test of an episode-based payment model. The proposed changes are part of CMS's annual release of the Inpatient Prospective Payment Systems (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System rule. The payment increase reflects a 3.2% market basket increase and a 0.8 percentage point productivity adjustment, amounting to a $1.4 billion increase in hospital payments.

CMS Announces Medicaid Cuts Affecting Thousands of Noncitizens

CMS Announces Medicaid Cuts Affecting Thousands of Noncitizens

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance that will result in thousands of individuals losing federally funded Medicaid or Children's Health Insurance Program (CHIP) benefits later this year. This change follows a law passed in 2025 that restricts federal funding for certain noncitizens. The guidance specifies that federal Medicaid and CHIP matching funds will now only be available for U.S. citizens, nationals, lawful permanent residents, certain Cuban and Haitian entrants, and migrants residing under the Compacts of Free Association. Refugees, asylees, parolees, and survivors of trafficking who do not meet these criteria will be affected. States are required to update eligibility systems and notify affected enrollees by October 1, when the new rules take effect.

Trump administration admits a glaring error in its accusations about New York health care fraud

Trump administration admits a glaring error in its accusations about New York health care fraud

President Donald Trump's administration has admitted to a major error in data used to justify a federal fraud probe into New York’s Medicaid program

AP Exclusive: Trump administration admits a glaring error in its New York health fraud accusations

AP Exclusive: Trump administration admits a glaring error in its New York health fraud accusations

President Donald Trump's administration has admitted to a major error in data used to justify a federal fraud probe into New York’s Medicaid program

Humana, Noom, and Welldoc Collaborate with b.well to Enhance Health Data Access for Medicare Beneficiaries

Humana, Noom, and Welldoc Collaborate with b.well to Enhance Health Data Access for Medicare Beneficiaries

Humana, Noom, and Welldoc have partnered with b.well Connected Health to improve access to health data for Medicare beneficiaries. This collaboration is part of a broader initiative by the Trump administration to enhance patient access to health information. The partnership allows Humana to access real-time data for better care coordination. Noom is integrating b.well's health data network to offer personalized health support through its app, particularly for weight loss and diabetes management. The new Health Record Connect feature enables Medicare members to link their clinical health records with the Noom app, providing tailored health insights. Welldoc is also leveraging this integration to offer AI-driven, personalized care for conditions like diabetes and obesity.

CMS Guidance to Cut Medicaid Coverage for Thousands by October

CMS Guidance to Cut Medicaid Coverage for Thousands by October

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance that will result in thousands of individuals losing federally funded Medicaid and Children's Health Insurance Program (CHIP) coverage later this year. This guidance is part of the Working Families Tax Cut legislation passed in 2025, which restricts federal funding for certain noncitizens. States must update eligibility systems and notify affected enrollees by October 1. The changes will primarily affect lawfully present noncitizens who were previously eligible for full benefits, including refugees and asylees. States can choose to provide state-funded coverage for those losing federal support, but are not required to do so.

Medicaid Work Rules to Challenge State Staffing Capacities

Medicaid Work Rules to Challenge State Staffing Capacities

The Trump administration's new Medicaid work rules, set to take effect on January 1, 2027, are expected to strain state staffing capacities significantly. These rules require states to verify Medicaid eligibility more frequently, every six months instead of annually, and implement work requirements for enrollees. The Congressional Budget Office estimates that these changes could lead to over 5 million people losing health coverage by 2034. States are already struggling with staffing shortages, which could be exacerbated by the new requirements. Many states report needing additional staff to manage the increased administrative workload, with some states like Idaho and New York planning to hire more employees to handle the changes.