Medicare & Medicaid
Bill would establish an electronic prior authorization process for MA plans, including standardization for transactions and clinical attachments.
The contracts do not favor managed care organizations that participate in the state's provider networks, according to plaintiffs.
The U.S. is experiencing a maternal health crisis, and has worse outcomes than in any other high-income country, according to OIG.
Enrollees in high-need areas often lack access to providers who can prescribe or dispense these medications, OIG finds.
Insurer is seeking an injunction, claiming the downgrade was based on an "arbitrary and capricious" assessment.
Prices for 25 drugs are expected to decrease for Medicare beneficiaries starting in 2026 and continuing into 2027.
Humana blames higher industry cut points and one contract decreasing to a 3.5-star rating from a 4.5-star rating in 2024.
The report compares cost, care, patient experience and more to brick-and-mortar care, ahead of the expiration of the waiver.
Various forms of a potential separation are reportedly under consideration, though specifics remain unclear.
To date, New York has refunded approximately $10 million to the federal government and recovered roughly $19 million in unallowable payments.