RISE summarizes recent regulatory-related headlines and reports.
Court again sides with feds over Humana’s Medicare Advantage Star ratings lawsuit
Judge Reed O’Connor of the Texas Northern District Court this week ruled in favor of the Centers for Medicare & Medicaid Services (CMS) and dismissed Humana’s case that the agency acted illegally when it downgraded its Stars ratings based on customer service calls. The case was dismissed with prejudice. Although the case can’t be refiled, Humana can still appeal the decision. This is the second time that Humana failed in its pursuit to recalculate its 2025 Star ratings. In July O’Connor dismissed the original case without prejudice, which allowed the case to be refiled. Meanwhile, Modern Healthcare reports that Humana is working on a strategy to improve its Star ratings. The insurer plans to move members into its top-scoring plans and away from plans that aren’t performing as well.
Commonwealth Fund: The best and worst states for Medicare
The Commonwealth Fund this week released its 2025 State Medicare Scorecard, which evaluates states based on more than 30 measures, including Medicare beneficiaries’ access to care, quality of care, health care costs, and population health. The data is based on information from the Centers for Medicare & Medicaid Services, federal surveys, and statistical data sites. The best states for access to health care, affordability, quality, and outcomes are Vermont, Utah, and Minnesota, according to the report. Louisiana, Mississippi, and Kentucky ranked the lowerst
Medicare Advantage marketing undergoes changes in 2025
Medicare beneficiaries won’t see the aggressive marketing campaigns for Medicare Advantage plans that they experienced in the past, according to Modern Healthcare. To control costs, Medicare Advantage insurers are focused on member retention and curtailing direct mail campaigns. They also are looking at digital channels to attract younger Medicare beneficiaries, the publication reports. The marketing research company Competiscan told Modern Healthcare that direct mail marketing for Medicare Advantage has dropped by 15 percent prior to open enrollment.
Senator seeks information on Medicare Advantage and AI
U.S. Senator Richard Blumenthal (D-Conn.), ranking member of the Permanent Subcommittee on Investigations (PSI), is raising concerns about Medicare Advantage insurers’ use of artificial intelligence to make health care decisions that may result in vulnerable seniors being denied critical care.
As AI continues to rapidly develop without adequate guardrails, Blumenthal is following up on previous findings to assess how Medicare Advantage insurers are using AI and other predictive technologies. In letters to UnitedHealthcare, CVS, and Humana, he has asked about the possibility for abuse of AI and how the insurers’ use AI and what policies they have in place to prevent predictive technologies from unduly influencing the work of human clinicians.
The government shutdown’s impact on nutrition program for women, infants, and children
Stateline reports that short-term funds will keep the U.S. Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) afloat through the end of October during the government shutdown. USA is transferring $300 million into WIC from its child nutrition programs account, which has been funded in part by tariff revenue from prior years, according to the publication. The transfer does not require congressional approval.