CMS is temporarily bringing furloughed employees back to work to help individuals sign up for health insurance plans during the open enrollment period. CMS told employees in an email obtained by Federal News Network that it is bringing back its furloughed employees, starting Monday, Oct. 27. The agency said it will repurpose some of its funding to ensure furloughed and excepted employees are paid on time for days worked during the open enrollment period.
The AHA Oct. 23 recommended changes to the CMS' Wasteful and Inappropriate Services Reduction model to address multiple concerns. The model is designed to use technology-enabled prior authorization to decrease services that CMS considers having little to no clinical benefit for some patients. The AHA expressed concerns about the WISeR model's payment structure for participating vendors, appeal rights, oversight on the use of AI, oversight of vendors used by Medicare Advantage plans, expansion of the model’s scope and its implementation timeline, among other details. The model, scheduled to begin Jan. 1, will be conducted in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. The AHA urged CMS to delay its implementation by at least six months.
The Trump administration is turning to an unconventional approach to lowering drug prices in the United States: striking deals directly with Big Pharma companies in an attempt to bring U.S. prices in line with what other countries pay. Trump and the nation's healthcare officials have touted these 'most-favored nation' deals as the most effective means to getting pharmaceutical prices down, beyond even the power of the Medicare drug price negotiations already in place. The key issue, health experts say, is that the public has had little visibility into these deals.
CMS Administrator Mehmet Oz, MD, said Wednesday that President Donald Trump has a plan to replace the Affordable Care Act — but provided no specifics about the proposal. 'I fully believe the president has a plan,' Oz told NBC News' 'Meet the Press' moderator Kristen Welker. 'We've been talking about it quite a bit. There's all kinds of ideas.'
Starting in 2026, Mayo Clinic will no longer be in-network for certain Medicare Advantage plans from two of the country's largest insurance providers. UnitedHealthCare and Humana both confirmed they would not provide certain Medicare Advantage plans for Mayo Clinic patients, starting Jan. 1, 2026. UHC stated employer-sponsored and Medicare Advantage Group Retiree plans would still be valid at Mayo locations, but those with individual plans and Dual Special Needs Plans who want to stay at Mayo, may need to look for different options.
Ballad Health is suing national insurance group United Healthcare, alleging that United systematically underpaid or failed to pay the hospital system for care provided to patients in United's Medicare Advantage program. The federal lawsuit, filed Tuesday in the Eastern District of Tennessee, claims United underpaid Ballad by more than $65 million over the past five years. It alleges four counts of breach of contract and one count of fraud and seeks both compensatory and punitive damages in amounts 'to be proven at trial.' Ballad Health said it will not renew its Medicare Advantage contract with UnitedHealth when it expires on June 30, 2027. More than two-thirds of the region’s Medicare patients use the Medicare Advantage program, and the majority of those get their insurance through United.