Medicare & Medicaid
As the fixed-loss amount for HCO cases continues to rise, LTCHs are incurring greater and greater losses, group says.
Participants will be given payments to support health IT capacity and infrastructure improvements.
For the program to continue into 2025, legislative action is needed.
Impacted payers need to send prior authorization decisions within 72 hours for urgent requests and seven days for standard requests.
Over 18% of consumers signing up for a plan are new to the marketplace, including some who formerly had Medicaid coverage.
The health system cited denials and delayed prior authorization requests in making the move, as well as its financial position.
Intermediate sanctions, effective on January 12, are due to low Medicare Advantage star ratings.
The approval, the agency says, allows New York to make large investments in wide-ranging Medicaid initiatives.
"We take our members and treat them really, really nicely," says CMO Neil Wagle.
Two of company's MA plans earned 5 stars in 2024, during a difficult year to rank highly in the Medicare Advantage star ratings.