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Health Plan Accountability Update: October 2025
The AHA May 29 submitted a letter to the Centers for Medicare & Medicaid Services responding to a request for information regarding Medicare Advantage data, urging CMS to increase oversight of the program.
Senate report says UHG used ‘aggressive strategies’ to increase MA payments
A Senate Judiciary Committee report released Jan. 12 found that UnitedHealth Group used “aggressive strategies” to maximize its Medicare Advantage risk-adjustment scores and collect higher payments from diagnoses of MA enrollees.
AHA urges MedPAC to recommend higher payment updates ahead of January meeting
The AHA Jan. 9 urged the Medicare Payment Advisory Commission to consider, during its next meeting Jan. 15-16, higher payment updates for the inpatient and outpatient prospective payment systems than those discussed in December and to examine Medicare Advantage’s role in access to care and provider financial stability.
CMS releases form for submitting provider complaints on Medicare Advantage plans
The Centers for Medicare & Medicaid Services has implemented an online form for providers to submit complaints regarding Medicare Advantage plans.
CMS announces pilot on MA service level data collection for initial determinations, appeals
The Centers for Medicare & Medicaid Services released a memo Dec. 16 announcing the agency’s intent to conduct a voluntary pilot in 2026, called the Service Level Data Collection for Initial Determinations and Appeals.
CMS Issues Proposed Rule for CY 2027 Medicare Advantage, Prescription Drug Plans
The Centers for Medicare & Medicaid Services (CMS) Nov. 28 released its proposed Policy and Technical Changes to the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program and Programs of All-Inclusive Care for the Elderly for Contract Year (CY) 2027.
CMS proposes 2027 Medicare Advantage, Part D policies
The Centers for Medicare & Medicaid Services Nov. 25 issued a proposed rule for policies governing the Medicare Advantage and Part D programs for 2027.
Voices on Value: A Conversation with William Shrank, M.D.
Priya Bathija, vice president of AHA’s The Value Initiative, talks with William Shrank, M.D., senior vice president and chief medical officer, Humana, to get his insights on health care affordability, value and the strategies that Humana is using to disrupt health care delivery.
AHA shares concerns, recommendations with CMS on WISeR model
The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address multiple concerns.