RISE summarizes recent regulatory-related headlines.
Cigna reportedly near deal to sell MA business
Cigna is close to a deal to sell its Medicare Advantage (MA) business to Health Care Service Corp. (HCSC) for approximately $4 billion, according to The Wall Street Journal. If the deal is finalized, it would expand HCSC’s reach in the market. Cigna offers Medicare plans in 29 states for 2024 and HCSC is the parent company of Blue Cross Blue Shield plans in five states. WSJ reports that the MA business had nearly $8 billion in revenue in 2022. The deal comes in the wake that the Justice Department reached a multi-million settlement with Cigna to resolve allegations that it violated the False Claims Act by submitting and failing to withdraw inaccurate diagnosis codes for its MA plan enrollees. Cigna has agreed to pay $172 million to settle the charges.
Senators call on CMS for guidance on MA members’ access to long-term care facilities
Two Senators from opposite sides of the aisle have asked the Centers for Medicare & Medicaid Services (CMS) to clarify that critically and chronically ill MA beneficiaries will have the same access to long-term care hospital services (LTCH) as traditional Medicare beneficiaries. Senator Chris Murphy (D-Conn.), a member of the U.S. Senate Health, Education, Labor, and Pensions Committee, and Senator Thom Tillis (R-N.C.) wrote that MA plan prior authorization practices have created significant barriers to LTCH for critically and chronically ill patients.
“Medicare Advantage beneficiaries are less than half as likely to receive LTCH care compared to traditional Medicare beneficiaries. Recent research suggests that these practices may be worsening the outcomes of Medicare Advantage beneficiaries; a 2021 peer-reviewed study found that delays in the transfer of mechanically ventilated patients to an LTCH decreased a patient’s likelihood of being successfully weaned from the ventilator and breathing on his or her own,” they wrote.
Furthermore, they said, LTCH in their states have regularly received denial letters from MA plans that claim a transfer to their facilities are not required because the patient could receive all necessary services in the short-term acute care hospital even though the provider referred the patient to the LTCH and the patient has met all the medical necessity requirements for LTCH care.
Consulting firm on trends to watch as ACA enters its second decade
Oliver Wyman, a global management consulting firm, predicts the next 10 years of the Affordable Care Act (ACA) will be more stable than its first decade. Analysts expect large national payers will expand offerings at a local level and create more sustainable partnerships with local health systems. As the ACA marketplace matures, the firm expects it will become like MA, with one or two major players dominating the space. “To be successful in the ACA, carriers need to have enough scale to allow them to price competitively, enter new markets, innovate on new products, and effectively capture Medicaid crossover,” analysts wrote.
The firm also believes more states will shift to state-based exchanges and it will become critical that plans offer a seamless member experience to enrollees. Consumers will stay with insurers that offer easy-to-use coverage, the ability to shop for the appropriate doctor, access to low-cost prescriptions, and has a hassle-free claims process. Click here to read the full analysis.