Humana up, Alignment down on 2027 star ratings
Plus: CD&R and McKesson take Option Care Health private. The day's rules, money, and enforcement, sourced and tiered below.
GENEROUS Medicaid drug pricing deal hits Sept 30 state deadline
Plus: CMS cancels ACA marketplace coverage for 760K people. The day's rules, money, and enforcement, sourced and tiered below.
CMS finalizes the TAVR coverage rewrite, heart team survives
Plus: Two hospitals, 1,300 miles apart, end labor and delivery the same night. The day's rules, money, and enforcement, sourced and tiered below.
Lilly pays up to $3.35B for InnoCare's undiscovered drug targets
Plus: OIG: Humana, UnitedHealthcare of Wisconsin overbilled Medicare $180M. The day's rules, money, and enforcement, sourced and tiered below.
CMS names first 79 ACOs in new 10-year LEAD Model
Plus: Elevance's Star Ratings summary judgment brief due tomorrow. The day's rules, money, and enforcement, sourced and tiered below.
BCBSA: hospital AI coding tools added $942M without extra care
Plus: Cigna embeds OpenAI frontier reasoning in oncology nurse workflows. The day's rules, money, and enforcement, sourced and tiered below.
Federal court vacates HHS Section 504 community integration rules nationwide
Plus: CMS partners with 37 states to overhaul Medicaid quality measurement. The day's rules, money, and enforcement, sourced and tiered below.
CMS publishes the Part D "reasonable and relevant" contract terms RFI
Plus: Merck restricts 340B covered entities to one contract pharmacy starting Oct 1. The day's rules, money, and enforcement, sourced and tiered below.
CMS cancels ACA coverage for 760,000, recovers $2.2B
Plus: Medicare aligns lab test pay with private insurers, $1B/yr savings. The day's rules, money, and enforcement, sourced and tiered below.
CMS finalizes the TAVR coverage rewrite, heart team survives
Plus: ACC asks CMS to delay mandatory heart-failure model, reverse procedure cuts. The day's rules, money, and enforcement, sourced and tiered below.
Oura's $2.2B IPO is mostly a payday for early investors
Plus: DexCare acquires AI care-coordination startup Mila Health. The day's rules, money, and enforcement, sourced and tiered below.
SCAN Health Plan reply brief due today in $125M star ratings suit
Plus: CMS restores $12B in Medicaid funding to Texas hospitals. The day's rules, money, and enforcement, sourced and tiered below.