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Recent MA News

Learn how to address managed care's impact on post acute with details on regulations & policy, analysis & research and recent MA news

Expanding Medicare Advantage co-pays may leave nursing homes without cash they’ve earned

December 9, 2024

McKnights

An increasing number of Medicare Advantage insurers are expected to institute nursing home co-pays starting Jan. 1, a change that could further hit providers already…

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Medicare Advantage Proves To Be the ‘Most Profound’ Disruptor for Nursing Homes, Reshaping Payer Dynamics

November 18, 2024

Skilled Nursing News

Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost…

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Medicare Advantage 2025 Spotlight: A First Look at Plan Offerings

November 15, 2024

Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a prominent role in the Medicare program. In 2024, nearly…

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How to Survive Medicare Advantage in Home Health

November 15, 2024

Rowan Report

Navigating the complexities of Medicare Advantage continues to be a sticking point for organizations trying to scale their business. In an education session at the 2024 Axxess…

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What the Outcome of the Election Could Mean for Medicaid

November 14, 2024

On the campaign trail, both former President Donald Trump and Vice President Kamala Harris are eager to portray themselves as guardians of Medicare. Each presidential…

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The Sickest Patients Are Fleeing Private Medicare Plans—Costing Taxpayers Billions

November 11, 2024

Wall Street Journal

Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying…

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Nursing Home Providers Adjust to Optum Exiting Medicare Advantage I-SNPs in Several Regions

November 5, 2024

Skilled Nursing News

Optum is scaling back its Medicare Advantage Special Needs Plans for nursing home and assisted living residents in several regions. The health care services arm…

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It’s UnitedHealth Group’s world — we just live in it

November 4, 2024

McKnights

…On Oct. 24 a report from the US Department of Health and Human Services Office of the Inspector General was published that was just the latest evidence…

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Denied but in denial no longer: Providers share successful Medicare Advantage strategies

October 31, 2024

McKnights

Document. Don’t delay. Designate a handler. Those were among top tips provided by managed care and skilled nursing experts who have fine-tuned their approach to…

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UnitedHealth Study: Is Medicare Advantage Killing Seniors

October 25, 2024

Rowan Report

Dr. Steve Landers has long been eloquent in his speaking and writing about the importance of Home Health over the years. Though I was already…

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“Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care

October 23, 2024

ProPublica

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their…

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Transition to Managed Medicaid Causing Chain Reaction of Challenges, as Nursing Homes Also Contend With Redetermination

October 15, 2024

Skilled Nursing News

Multiple states have been working toward a transition to managed Medicaid from the traditional state-run program, but there have been concerns about reimbursement timing and…

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Inside Covenant, American Health Plans’ Strategies to Keep Nursing Home Managed Care Burdens in Check

September 27, 2024

Skilled Nursing News

In weathering the rise of managed care penetration – which has often meant lost profits – nursing homes are turning to centralized processes for handling…

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TEAM Model Gives Nursing Homes Another Lever for Medicare Advantage Negotiations

September 6, 2024

Skilled Nursing News

Negotiating power with Medicare Advantage (MA) plans may become easier as nursing homes explore participation in bundled payment options such as the Transforming Episode Accountability…

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Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

August 8, 2024

GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom…

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CMS Issues Flurry of Medicare Advantage Regulation Amid Audits, But Lack of Clarity Muddies Effectiveness

July 15, 2024

Skilled Nursing News

There’s been a flurry of regulatory activity related to Medicare Advantage (MA) in the first half of this year, with many policy actions being the…

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Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care

June 28, 2024

McKnights

The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a…

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Stop allowing MA plans to use AI to deny care without review, lawmakers urge CMS

June 25, 2024

STAT

A bipartisan group of lawmakers is urging the Biden administration to prohibit Medicare Advantage insurers from using artificial intelligence tools to deny care until it…

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10 Things to Know About Medicaid Managed Care

May 1, 2024

Managed care is the dominant delivery system for Medicaid enrollees. The latest national Medicaid managed care enrollment data (from 2021) show 74% of Medicaid beneficiaries were enrolled…

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Successfully Navigating the Pain Points of Medicare Advantage at Nursing Homes

March 8, 2024

Skilled Nursing News

The growing prevalence of Medicare Advantage (MA) plans in many skilled nursing markets has been a source of mounting challenges for operators, many of whom…

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Medicare Advantage is bad for patients and bad for investors

February 28, 2024

STAT

“In 2023, enrollment in Medicare Advantage, the version of Medicare run by private insurers, surpassed 50% of eligible beneficiaries for the very first time. Going…

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Class action suit targets Medicare Advantage insurer’s use of AI to end rehab stays

December 14, 2023

McKnights

Two skilled nursing patients filed a class action suit against Humana Tuesday — alleging their Medicare Advantage benefits were cut prematurely short because of Humana’s…

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UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

November 14, 2023

STAT

The nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations,…

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UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans

November 14, 2023

STAT

A class action lawsuit was filed Tuesday against UnitedHealth Group and a subsidiary alleging that they are illegally using an algorithm to deny rehabilitation care…

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How UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care

July 11, 2023

STAT

Frustration was boiling into open conflict within NaviHealth, a company that uses computer predictions to help control the cost of caring for millions of older…

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Find More Medicare Advantage Resources

CMS’ Medicare Benefit Policy Manual

October 5, 2023

The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…

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HHS-OIG’s Efforts Result in $7.13 Billion in Expected Recoveries and Receivables

December 4, 2024

America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds as a result of work by the Department of Health…

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Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program

November 26, 2024

On November 26, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part…

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Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care

October 24, 2024

US Senate

The Senate Homeland Security and Governmental Affairs Committee’s majority staff report on Medicare Advantage highlights three key takeaways regarding overpayments and manipulative practices: Medicare Advantage plans are significantly overpaid: The…

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