Inside the Medicare Advantage Reform Act

A bill currently before Congress seeks to overhaul aspects of the Medicare Advantage program. Rep. David Schweikert (R-Ariz.) recently introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage (MA). A key provision of the bill is a proposed requirement that MA plans pay […]

Proposed California Budget Calls for Prior Authorization for Hospice in Medicaid

The proposed California budget would require prior authorizations for hospice care within the state’s Medicaid program. Currently, Medicaid managed care plans who provide coverage through the state’s Medicaid system, Medi-Cal, may not perform prior authorizations for hospice. California’s Department of Health Care Services (DHCS) indicated in a 2025-2026 budget revision that this could save $25 […]

Proposed Bill Would Require MA to Pay for Hospice Care 

Rep. David Schweikert (R-Ariz.) has introduced the Medicare Advantage Reform Act, which among other provisions would require health plans to pay for hospice care. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage program. It would mandate capitated payment models, change risk adjustment methodologies and create new exemptions for […]

UnitedHealth Group Reportedly Under Criminal Investigation for Alleged Medicare Fraud

The insurance and health care company UnitedHealth Group (NYSE: UNH) may be under federal criminal investigation for alleged Medicare fraud. The U.S. Justice Department has not released the specific allegations against the company. However, they are reportedly related to UnitedHealth Group’s business practices within its Medicare Advantage plans, according to the Wall Street Journal, which […]

Regulation Complicating Hospice AI Implementation

An evolving regulatory landscape may be complicating hospices’ ability to effectively implement and use artificial intelligence technology. The top legal considerations involving AI center around protecting patient privacy and ensuring transparent innovation. Hospices have leveraged AI to better predict patient trajectories, ease employees’ administrative burden, boost retention, and improve compliance and operational efficiency, among other […]

Wisconsin State Assembly Approves Bill Establishing Palliative Care Council

The Wisconsin State Assembly has approved a bill requiring the state’s Department of Health Services (DHS) to create a statewide palliative care council. A group of 22 palliative clinical professionals, patients and family members would comprise the council to help address care delivery issues and raise awareness in the field. The council would also include […]

CMMI Takes New 3-Pronged Strategic Direction Amid ‘Critical Juncture’ in Health Care

The Center for Medicare and Medicaid Innovation (CMMI) will implement a new, three-pronged strategic direction aimed at improving access and outcomes while reducing health care costs. More seriously ill individuals are living longer with multiple comorbidities, a trend that has increasingly overburdened and financially strained the health care system and families across the country, according […]

DOJ Rejects Amedisys, UnitedHealth’s Divestiture to BrightSpring, Pennant

The U.S. Department of Justice (DOJ) has rejected the sale of Amedisys’ (Nasdaq: AMED) home health and hospice assets to BrightSpring Health Services Inc. (Nasdaq: BTSG) and The Pennant Group (Nasdaq: PNTG) as a remedy to an ongoing lawsuit. Amedisys earlier this month announced the divestiture of a number of its home health and hospice […]

[UPDATED] Advocacy Groups: Medicaid Cuts Would Adversely Impact Home-, Community-Based Services

A tax bill currently before Congress could lead to Medicaid cuts that would inhibit access to home- and community-based services (HCBS). The bill, which promises sweeping tax and spending cuts, currently is undergoing a reconciliation process. The amount of tax cuts could reach $4.5 trillion, with spending cuts in the area of $4.5 billion, with […]