News

CMS Releases Unwinding Renewal Timeline with Estimated End Dates for Nine States

• On June 13, CMS released a slide deck describing updates to state-specific unwinding renewal timelines. Initially, CMS gave states one year from April 1, 2023, when Medicaid continuous enrollment protections expired, to initiate unwinding procedures and 14 months to complete them. This was later extended to June 2024, but many states requested additional extensions for a variety of reasons, including the need for more time to complete renewals for vulnerable populations, such as children and individuals receiving long term care. Currently, there are 9 states that plan to forgo the deadline and end their unwinding later than scheduled. Illinois, Kentucky, Michigan, New Jersey, and Wisconsin are to finish in July, South Carolina and Hawaii in August, and North Carolina in November. Washington D.C. and Alaska, on the other hand, will finish their unwinding renewals in 2025, citing “unique and severe environmental and operational challenges.” (Inside Health Policy, June 13; CMS; June 13).

CMS to Recalculate Medicare Advantage Plan 2024 Star Ratings

• On June 13, CMS notified Medicare Advantage (MA) plans that it will recalculate the 2024 Star Ratings for the 2025 Quality Bonus Payment as a result of recent D.C. district court decisions. The D.C. district court judges largely sided with SCAN Health Plan and Elevance Health in their cases against CMS over the methodology behind the 2024 quality ratings. Health plans that earned a rating of at least 3.5 stars have from June 26 to June 28 to submit revised plan bids if their ratings increased by a half star or more with the new calculations but must notify CMS of their intent by June 18. If a plan’s score is lower with the new recalculation, its quality bonus payments rating will not decrease (Fierce Healthcare, June 14; Inside Health Policy, June 13).

Federal Legislation

Bipartisan Prior Authorization Legislation for MA Plans Reintroduced

• On June 12, a bipartisan group of lawmakers in both chambers of Congress reintroduced legislation to streamline Medicare Advantage (MA) prior authorizations (PA) after a previous effort stalled in the Senate in 2022. The “Improving Seniors’ Timely Access to Care Act of 2024” aims to establish an electronic PA process and increase transparency about its use and requirements. Additionally, the bill would require MA plans to report their PA data to HHS, set time frames for requests, and waive or modify PA requirements for qualified providers and suppliers. The legislation is supported by 42 Senators, 130 House members, and more than 370 organizations including CVS Health, the American Medical Association, and the American Hospital Association. The bill would codify provisions from a final rule released earlier this year by CMS that streamlines the PA process in MA, CHIP, and Medicaid (Health Payer Specialist, June 14).

Federal Studies and Reports

CBO Releases Report on Hepatitis C Treatment Cost Savings

• One June 14, the Congressional Budget Office (CBO) released a report detailing the cost savings of expanding hepatitis C treatment, specifically for Medicaid enrollees. The report also discussed the importance of additional research on treatments and patient outreach and the increased costs associated with not treating the disease. However, advocates noted that the report did not include patients outside of the government program and were hopeful of including a larger population in future implementation and advocacy. The report underscored the importance of long-term budgetary assessments beyond the standard 10-year window given the slow progression of the disease. According to sources in the Senate, there may be new legislation forthcoming to expand access to hepatitis C treatment given the positive CBO report (Inside Health Policy, June 14).