Tag: Medicare Advantage
Bill seeks to eliminate prior authorization for wheelchair repairs
June 25, 2026HME News Staff
WASHINGTON – Rep. Ayanna Pressley, D-Mass., has introduced legislation that would remove prior authorization requirements from Medicare Advantage plans for maintenance and repairs to wheelchairs and other complex rehab technology (CRT).
“When a wheelchair breaks down, daily life is disrupted,” said Pressley. “I’m grateful to my constituents and our disability justice advocates for informing this vital legislation.”
Pressley announced the “Facilitating...
AAHomecare throws weight behind Medicare Advantage reforms
June 19, 2026HME News Staff
WASHINGTON – AAHomecare has sent letters of support to the sponsors of legislation in the House and Senate that would reform Medicare Advantage prior authorization, claims integrity and transparency.
In its letters to Rep. John Joyce, R-Pa., and Sen. Roger Marshall, R-Kan., the organization shared how the bills would address challenges that home medical equipment (HME) providers face daily and would improve access to medical necessary equipment for Medicare beneficiaries.
“These...
In brief: Dems drop MA bill, Soleo launches new brand, VGM partners with HME360
April 24, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...
Dems introduce bill to eliminate prior auths for MA plans
April 23, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...
In brief: CMS ups MA payments, Sleep Cycle sees interest, Soleo Health expands
April 10, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has set a net average increase of 2.48% for Medicare Advantage plans in calendar year 2027, representing more than $13 billion in additional payments.
Earlier this year, CMS had proposed a net average increase of 0.09%, representing $700 million in additional payments.
CMS touts improved payment accuracy
In a new rate announcement, the agency says this expected increase includes consideration of the various elements that...
CMS ups payment increase for Medicare Advantage
April 9, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has set a net average increase of 2.48% for Medicare Advantage plans in calendar year 2027, representing more than $13 billion in additional payments.
Earlier this year, CMS had proposed a net average increase of 0.09%, representing $700 million in additional payments.
CMS touts improved payment accuracy
In a new rate announcement, the agency says this expected increase includes consideration of the various elements that...
CMS switches to C2C Innovative Solutions for Medicare Advantage appeals
April 6, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has awarded the Part C Independent Review Entity (IRE) contract to C2C Innovative Solutions. Effective May 1, 2026, C2C will be responsible for conducting appeals of adverse reconsiderations issued by Part C plans, as well as reviews of plan dismissals of appellant reconsideration requests. The existing Part C IRE, Maximus, will continue to process appeal requests received on or before April 30, 2026. Appeal requests received on...
MedPAC report recommends increased pay for physicians, increased oversight of Medicare Advantage
March 16, 2026HME News Staff
WASHINGTON – The Medicare Payment Advisory Committee (MedPAC) recommends updating payments above current law for physicians and other health care professional services. It also recommends eliminating the update for outpatient dialysis services and hospice services; and reducing payments for skilled nursing facilities, home health agencies and inpatient rehabilitation facilities.
In its March 2026 Report to the Congress: Medicare Payment Policy, MedPAC also recommends updating payments at...
CGM use increases to one in six Medicare Advantage members, study finds
March 16, 2026HME News Staff
LOUISVILLE, Ky. – There was a notable increase in the use of continuous glucose monitors (CGMs) among Medicare Advantage members with Type 2 diabetes from 2021-23, according to a new study published in the current issue of the Journal of Managed Care & Specialty Pharmacy (JMCP) and conducted by a Humana Healthcare Research team and Dr. Joseph S. Ross of the Yale School of Medicine.
The proportion of Medicare Advantage members with Type 2 diabetes who use insulin and CGMs increased from fewer...
CMS notifies Elevance Health it may suspend enrollment capabilities
March 3, 2026HME News Staff
WASHINGTON – The Centers for Medicare and Medicaid Services (CMS) will suspend Elevance Health’s ability to enroll people in its Medicare Advantage plans if the insurer doesn’t comply with risk adjustment data submission requirements.
In a Feb. 27 letter to Elevance, CMS said sanctions would begin March 31 for Elevance’s “pattern of knowing noncompliance.”
In its letter, CMS states: Since November...