Category: CMS
-
STAT+: Trump can’t break free from vaccine politics
STAT+: Trump can’t break free from vaccine politics You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. And you may find yourself climbing a StairMaster next to RFK Jr. Send news tips and vague Talking…
-
STAT+: CMS halts enrollment in Elevance’s Medicare Advantage plans, citing years of misconduct
STAT+: CMS halts enrollment in Elevance’s Medicare Advantage plans, citing years of misconduct Elevance Health will no longer be able to enroll people into its Medicare Advantage plans starting March 31, according to a new, harshly worded suspension notice from the Centers for Medicare and Medicaid Services. CMS is imposing the punishment after Elevance failed…
-
CMS announces pause on new durable medical equipment suppliers
CMS announces pause on new durable medical equipment suppliers The Trump administration announced Wednesday a nationwide moratorium on new suppliers for certain medical equipment, citing a need to get a handle on the “fraud, waste, and abuse” in the industry that provides wheelchairs, artificial limbs and other equipment. “The amount of fraud is so massive…
-
STAT+: HHS adviser hopes prior authorization reform happens in ‘double-digit months,’ not years
STAT+: HHS adviser hopes prior authorization reform happens in ‘double-digit months,’ not years WASHINGTON — A top U.S. health official told a room full of doctors on Wednesday that he hopes the Trump administration’s efforts to whittle down the insurance industry’s use of prior authorizations will produce results “in double-digit months” instead of years, calling…
-
STAT+: Drugmakers lay out their legal arguments against Trump’s drug pricing experiments
STAT+: Drugmakers lay out their legal arguments against Trump’s drug pricing experiments WASHINGTON — The pharmaceutical and biotech industries are pushing back against two Trump administration proposals that would test plans to lower drug prices in Medicare by aligning them with the prices paid in other rich countries. Their comments preview arguments that they might…
-
STAT+: The federal directory of doctors and hospitals is coming this year
STAT+: The federal directory of doctors and hospitals is coming this year After years of grand ambitions, the federal government disclosed that it is months away from rolling out a centralized list of doctors and hospitals filled with up-to-date contact and insurance information. Details of how the national provider directory will work are scant —…
-
STAT+: Medicare Advantage growth dwindles for a second straight year
STAT+: Medicare Advantage growth dwindles for a second straight year The Medicare Advantage program continues to bring in more older adults and people with disabilities, but not nearly at the same rates from just a few years ago. Almost 35.5 million people were enrolled in a Medicare Advantage plan as of Feb. 1, up roughly…
-
Major shakeup underway at HHS as White House braces for midterms
Major shakeup underway at HHS as White House braces for midterms WASHINGTON — Two top health officials are leaving their jobs amid a shakeup at the Department of Health and Human Services aimed at refocusing HHS on politically popular aspects of health secretary Robert F. Kennedy Jr.’s agenda in advance of the midterm elections. Deputy…
-
STAT+: The messaging war over Medicaid cuts
STAT+: The messaging war over Medicaid cuts You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. Dr. Oz seems to have invited Jeffrey Epstein to a Valentine’s Day party in 2016, about eight…
-
STAT+: Trump officials push for skimpier coverage in ACA marketplaces
STAT+: Trump officials push for skimpier coverage in ACA marketplaces Trump health officials are proposing changes that would water down the options for people who buy their own health insurance through Affordable Care Act marketplaces. The proposals, released this week and which would go into effect in 2027, prioritize making ACA premiums as low as…
-
STAT+: As Republicans face attacks for cutting Medicaid funding, Dr. Oz blames states with big cities
STAT+: As Republicans face attacks for cutting Medicaid funding, Dr. Oz blames states with big cities The Trump administration is reframing the steep Medicaid cuts in Republicans’ tax bill to pit states with large urban centers against those with large rural populations. Last year, Republicans passed Trump’s signature legislative accomplishment, a bill that partially offset…
-
What to know about TrumpRx, the Trump administration’s prescription drug platform
What to know about TrumpRx, the Trump administration’s prescription drug platform President Trump on Thursday night is planning to announce the launch of TrumpRx, the website that he and his aides have touted for months as a platform aimed at lowering prescription drug prices. The website, which uses technology from health care company GoodRx, is…
-
Newsom files a civil rights complaint against CMS’ Oz in latest feud with the Trump administration
Newsom files a civil rights complaint against CMS’ Oz in latest feud with the Trump administration LOS ANGELES — California Gov. Gavin Newsom’s office is demanding a civil rights investigation of Dr. Mehmet Oz, saying he discriminated against Armenians in a video claiming hospice fraud in Los Angeles, the latest front in the state’s ongoing battle with the…
-
STAT+: Trump’s latest deal: $600 million of tech company discounts to help implement Medicaid work requirements
STAT+: Trump’s latest deal: $600 million of tech company discounts to help implement Medicaid work requirements Ten technology vendors are offering $600 million worth of discounts to states that pick them to help implement Medicaid work requirements, the Trump administration announced Thursday, signaling how lucrative they think the sweeping change could be. Mehmet Oz, administrator…
-
STAT+: Trump administration signals there’s widespread desire to curb Medicare Advantage
STAT+: Trump administration signals there’s widespread desire to curb Medicare Advantage Health insurers have endured a litany of problems with Medicare Advantage over the past three years. They were optimistic things would turn around with the Trump administration in charge. Tough luck, for now. The administration stunned Medicare Advantage insurers and their investors by proposing…
-
Medicare proposes new transplant system rules that might spur use of less-than-perfect organs
Medicare proposes new transplant system rules that might spur use of less-than-perfect organs WASHINGTON — The government proposed new rules for the nation’s transplant system Wednesday that aim to increase use of less-than-perfect organs and set additional safety standards for donor groups. The Centers for Medicare and Medicaid Services said the proposal would strengthen its oversight of organ procurement…
-
A measles outbreak and hospitals’ financial troubles
A measles outbreak and hospitals’ financial troubles Why is the U.S. at risk of losing its measles elimination status? How are health officials reacting to the measles outbreak? And what did top Centers for Medicare and Medicaid Services official Mehmet Oz tell hospital executives at a fancy yacht party in San Francisco? We discuss all…
-
STAT+: UnitedHealth has turned Medicare Advantage coding into ‘profit-centered strategy,’ Senate report finds
STAT+: UnitedHealth has turned Medicare Advantage coding into ‘profit-centered strategy,’ Senate report finds UnitedHealth Group’s colossal size has helped the conglomerate turn the way patients are coded in the Medicare Advantage program into “a major profit-centered strategy, which was not the original intent of the program,” according to a new report released Monday from the…
-
STAT+: CMS divvies up first payments from $50B rural health fund, with an eye toward MAHA goals
STAT+: CMS divvies up first payments from $50B rural health fund, with an eye toward MAHA goals WASHINGTON — The Trump administration on Monday announced the distribution of the first payments from a new $50 billion rural health fund — but not all states are getting equal payouts. The administration is giving larger awards to…
-
Opinion: Proposed HHS rule on gender-affirming care radically expands use of Medicare, Medicaid as policy weapons
Opinion: Proposed HHS rule on gender-affirming care radically expands use of Medicare, Medicaid as policy weapons Last Thursday, the Trump administration released a proposed rule prohibiting hospitals that receive Medicare or Medicaid funding from providing any gender affirming care to minors, even when privately funded. This rule will foreclose access to gender-affirming care for families seeking…
-
STAT+: Trump moves to require lower drug prices in Medicare
STAT+: Trump moves to require lower drug prices in Medicare You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. The NIH director did the Pete & Bobby fitness challenge, but I didn’t see…
-
STAT+: Trump administration proposes Medicare pilots to lower drug prices on par with peer countries
STAT+: Trump administration proposes Medicare pilots to lower drug prices on par with peer countries WASHINGTON — The Trump administration proposed two Medicare pilot programs to reduce prices for branded drugs bought at pharmacy counters and administered in doctor offices. If the administration moves forward, the programs could slash Medicare spending on prescription drugs by…
-
STAT+: Pharmaceutical industry evades drug price transparency, again
STAT+: Pharmaceutical industry evades drug price transparency, again Drug manufacturers and pharmacy benefit managers received a holiday gift from President Trump on Friday: They still will not have to publicly post the actual prices of prescription drugs, more than five years after federal law required them to do so. Net drug prices — the amounts…
-
In major effort to end gender-affirming care, Trump administration takes aim at hospitals
In major effort to end gender-affirming care, Trump administration takes aim at hospitals The Trump administration is making its most forceful attempt yet at restricting gender-affirming care for transgender youth in the U.S. The Centers for Medicare and Medicaid Services proposed on Thursday two rules to withhold federal funds in connection with gender-affirming care for…
-
STAT+: Medicare routes $16 billion to insurers to offset high drug costs
STAT+: Medicare routes $16 billion to insurers to offset high drug costs The federal government has sent a record $16 billion to health insurers that sell Medicare drug plans, a flashing red sign that prescription drug spending is blowing up far beyond what government officials and insurance experts had expected. The good news for Medicare…
-
Opinion: Pharmacies will be the canary in the coal mine on the Medicare drug price negotiations
Opinion: Pharmacies will be the canary in the coal mine on the Medicare drug price negotiations The Centers for Medicare and Medicaid Services recently announced negotiated prices for 15 drugs, finalizing the second iteration of the Medicare Drug Price Negotiation Program. The first set of negotiated drug prices will go into effect in January 2026.…
-
STAT+: Medicare Advantage plans to gain $13 billion under Trump changes to star ratings
STAT+: Medicare Advantage plans to gain $13 billion under Trump changes to star ratings Medicare Advantage insurers scored a Thanksgiving gift, as President Trump’s Medicare agency added back a bonus system that rewards health plans with consistently high marks. The Centers for Medicare and Medicaid Services also is proposing to eliminate a dozen star ratings…
-
STAT+: Medicare backs off plan for quicker clawback of $7.8 billion from hospitals
STAT+: Medicare backs off plan for quicker clawback of $7.8 billion from hospitals Hospitals scored a win in Medicare’s final outpatient payment rule for 2026, as they persuaded federal Medicare officials to back off a plan that would have clawed back $7.8 billion a decade sooner than originally planned. However, hospitals didn’t get everything they…
-
STAT+: States might not get cheaper drugs in Trump’s most-favored nation Medicaid pilot program
STAT+: States might not get cheaper drugs in Trump’s most-favored nation Medicaid pilot program WASHINGTON — When President Trump announced the administration’s deal to cut prices for weight-loss drugs, he proclaimed that “you will pay the lowest price anywhere in the world.” But state Medicaid programs might already be getting lower prices, according to a research…
-
STAT+: Seven burning questions about Trump’s big deal for cheaper weight loss drugs
STAT+: Seven burning questions about Trump’s big deal for cheaper weight loss drugs WASHINGTON — The Trump administration’s deal to expand access to and lower the cost of weight loss drugs has left industry leaders, public health experts, and patients with a host of open questions. The administration’s agreements with Eli Lilly and Novo Nordisk…
-
STAT+: Medicare finalizes rule to lower payments for surgeries
STAT+: Medicare finalizes rule to lower payments for surgeries Medicare on Friday followed through with its earlier proposal to reduce payment for surgeries, outpatient procedures, and other services it believes can be done more efficiently starting in 2026. The controversial move represents a significant change to how thousands of physician services are priced under Medicare.…
-
STAT+: States reject Dr. Oz’s claims of Medicaid spending on undocumented immigrants
STAT+: States reject Dr. Oz’s claims of Medicaid spending on undocumented immigrants WASHINGTON — Centers for Medicare and Medicaid Services Administrator Mehmet Oz said Friday that “more than $1 billion of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants” by five states and the District of Columbia in recent months. But…
-
STAT+: Casey Means faces confirmation hearing for surgeon general
STAT+: Casey Means faces confirmation hearing for surgeon general You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. The wife and I went to the Rehoboth Beach Sea Witch Festival dressed as a…
-
STAT+: Kaiser Permanente, DOJ nearing resolution in $1 billion Medicare fraud case
STAT+: Kaiser Permanente, DOJ nearing resolution in $1 billion Medicare fraud case The Justice Department and Kaiser Permanente are nearing a deal in their behind-the-scenes negotiations over the government’s claim that the California health care giant bilked Medicare out of $1 billion. The federal judge overseeing the DOJ’s long-running case against Kaiser on Friday granted…
-
STAT+: Medicare payments to doctors paused as government shutdown drags on
STAT+: Medicare payments to doctors paused as government shutdown drags on The Centers for Medicare and Medicaid Services is pausing Medicare payments to doctors, as negotiations tied to the government shutdown drag on. CMS announced the pause in a notice on its website but didn’t say when it would end. It’s happening because Congress needs…
-
Home hospital programs in ‘terror’ as they grind to halt ahead of government shutdown
Home hospital programs in ‘terror’ as they grind to halt ahead of government shutdown On any given day, dozens of patients waiting for hospital rooms line the hallways of the emergency department at UMass Memorial Medical Center’s University Campus. It’s one reason the Worcester-based health system dove into delivering home hospital care four years ago. …
-
STAT+: Patients set to lose hospital care at home if government funding isn’t extended
STAT+: Patients set to lose hospital care at home if government funding isn’t extended WASHINGTON — If Congress doesn’t fund the government by the end of the day on Tuesday, patients across the country who have been receiving hospital-level care at home will be placed back in hospitals. The Acute Hospital Care at Home initiative…
-
Trump administration to close Miami organ donation group it calls ‘failing’
Trump administration to close Miami organ donation group it calls ‘failing’ WASHINGTON — The Trump administration moved Thursday to shut down a Miami organ donation group, calling it “failing” because of underperformance, unsafe practices and paperwork errors. The Life Alliance Organ Recovery Agency is one of 55 organ procurement organizations, or OPOs, nonprofit agencies around…
-
STAT+: CMS delays rule requiring Medicare Advantage insurers to remind members of unused benefits
STAT+: CMS delays rule requiring Medicare Advantage insurers to remind members of unused benefits Medicare is delaying implementation of a Biden-era rule that would have made Medicare Advantage plans notify members about their unused supplemental benefits — services such as vision and dental. Even though taxpayers hand health insurers more than $80 billion each year…
-
STAT+: How Trump may use Democrats’ drug-price negotiation law
STAT+: How Trump may use Democrats’ drug-price negotiation law You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. I’m happy to report that Last Week Tonight with John Oliver did a segment on…
-
STAT+: Elevance loses lawsuit over Medicare Advantage quality ratings
STAT+: Elevance loses lawsuit over Medicare Advantage quality ratings A federal judge in Texas struck down Elevance Health’s lawsuit that argued the government unfairly lowered its Medicare Advantage quality ratings — a decision that could cost Elevance $375 million in bonus revenue. U.S. District Judge Mark T. Pittman, appointed by President Trump in 2019, chastised…
-
STAT+: Health care and tech companies promise CMS they’ll make patient data more accessible
STAT+: Health care and tech companies promise CMS they’ll make patient data more accessible On Wednesday, over 60 health tech companies signed a pledge orchestrated by the Centers for Medicare and Medicaid Services to make health data-sharing easier and to build apps for patients to access and act on their health data. CMS Administrator Mehmet…
-
STAT+: Judge dismisses Humana’s case over downgraded Medicare Advantage ratings
STAT+: Judge dismisses Humana’s case over downgraded Medicare Advantage ratings A federal judge on Friday tossed out a lawsuit from Humana that attempted to reinstate higher quality ratings to its 2025 Medicare Advantage plans. The ruling jeopardizes billions of dollars in taxpayer-funded bonuses that Humana gets from the government’s star ratings program. However, Humana said…
-
STAT+: Dr. Oz tries to seal the deal on Trump’s tax-cut bill
STAT+: Dr. Oz tries to seal the deal on Trump’s tax-cut bill WASHINGTON — As GOP leadership pushes to pass President Trump’s tax megabill this week, one administration official has been working hard behind the scenes to close the deal: Mehmet Oz, who oversees Medicare and Medicaid. House Republicans, including those on the fence about…
-
STAT+: Health insurers promise to reduce barriers to care under pressure from Trump administration
STAT+: Health insurers promise to reduce barriers to care under pressure from Trump administration WASHINGTON — Last week’s pledge from more than 40 health insurers to cut down on prior authorizations came after some behind-the-scenes convincing from the Trump administration. The administration pushed insurers to sign a voluntary pledge to cut back on prior authorizations…
-
STAT+: Republicans lean in to new Medicaid cuts
STAT+: Republicans lean in to new Medicaid cuts You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. It’s a short, busy week on Capitol Hill. I hope you have Juneteenth off, but I…
-
Trump administration revokes guidance requiring hospitals to provide emergency abortions
Trump administration revokes guidance requiring hospitals to provide emergency abortions WASHINGTON — The Trump administration announced on Tuesday that it would revoke guidance to the nation’s hospitals that directed them to provide emergency abortions for women when they are necessary to stabilize their medical condition. That guidance was issued to hospitals in 2022, weeks after the U.S. Supreme Court…
-
STAT+: Trump, building on Biden policy, to speed up audits of Medicare Advantage insurers
STAT+: Trump, building on Biden policy, to speed up audits of Medicare Advantage insurers President Trump’s federal Medicare agency will expedite audits of Medicare Advantage insurers, a move that could claw back nearly $500 million a year for taxpayers, according to previous federal estimates. However, the audits remain mired in a two-year-old lawsuit initiated by…
-
STAT+: UnitedHealth’s Optum working on Medicare risk scoring system that would use AI
STAT+: UnitedHealth’s Optum working on Medicare risk scoring system that would use AI SAN DIEGO — Optum, the health data and care provider division of UnitedHealth Group, is developing a way to calculate how sick Medicare patients are through artificial intelligence, instead of relying solely on diagnosis codes submitted by physicians. Ken Cohen, a physician…
-
STAT+: Our biggest burning questions on Trump’s order to bring down drug prices
STAT+: Our biggest burning questions on Trump’s order to bring down drug prices WASHINGTON — President Trump’s executive order to lower drug prices through sweeping, cross-agency action left leaders in the pharmaceutical industry scrambling Monday to make sense of what may be ahead — and how to respond. The announcement was long on messaging, but…
-
STAT+: Trump to end federal funding of certain non-medical services in Medicaid
STAT+: Trump to end federal funding of certain non-medical services in Medicaid WASHINGTON — The Trump administration said Thursday that it will no longer help states fund non-medical services that often are aimed at improving housing and nutrition for people in the Medicaid program. The change is a departure from the Biden administration’s efforts to…
-
STAT+: RFK Jr.’s Senate hearing delayed, living with more measles
STAT+: RFK Jr.’s Senate hearing delayed, living with more measles You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. STAT is cutting the price of an annual subscription in half. Click here for…
-
STAT+: Study shows how UnitedHealth uses coding to rake in extra cash from Medicare Advantage
STAT+: Study shows how UnitedHealth uses coding to rake in extra cash from Medicare Advantage Health insurers in the private Medicare business have a big incentive to diagnose their members with lots of health conditions: The government pays them more money. A new study shows the extent to which the biggest player in that business,…
-
STAT+: Trump gives major lift to 2026 Medicare Advantage payments
STAT+: Trump gives major lift to 2026 Medicare Advantage payments Health insurers that sell Medicare Advantage plans are going to get about $30 billion more in taxpayer money next year. President Trump’s Medicare agency finalized a rule Monday that would raise benchmark payment rates to privatized Medicare plans by 5.1% for 2026. That was higher…
-
STAT+: Medicare gets a big (unofficial) surprise: a 17-year extension on when it’ll run dry
STAT+: Medicare gets a big (unofficial) surprise: a 17-year extension on when it’ll run dry Medicare’s financial future unexpectedly got a lot rosier, at least according to some federal budget wonks. The Congressional Budget Office recently published its long-term predictions of the federal budget and buried a big surprise for people who follow the Medicare…
-
Senate confirms Oz as head of agency that runs Medicare, Medicaid
Senate confirms Oz as head of agency that runs Medicare, Medicaid WASHINGTON — In a party-line vote of 53-45, the Senate on Thursday confirmed Mehmet Oz to lead the Centers for Medicare and Medicaid Services. Oz’s confirmation was expected; he is not as controversial as Health and Human Secretary Robert F. Kennedy Jr. or some…
-
STAT+: HHS layoffs rile Democrats, but Republicans say they trust RFK Jr.’s cuts will not hamper core operations
STAT+: HHS layoffs rile Democrats, but Republicans say they trust RFK Jr.’s cuts will not hamper core operations WASHINGTON — News of massive layoffs at the Health and Human Services Department was met with anger and predictions of lawsuits by Democratic lawmakers, and with a shrug by Republicans. HHS Secretary Robert F. Kennedy Jr. announced…