The Center for Medicare and Medicaid Services (CMS) announced last month that it is ending four Innovation Center models early: Primary Care First, End-Stage Renal Disease (ESRD) Treatment Choices, Making Care Primary, and Maryland Total Cost of Care. The models will end by December 31, 2025. Additionally, two previously announced but not yet implemented models…

On August 1, 2024, the National Committee for Quality Assurance (NCQA) released accreditation standards for Virtual Primary Care and Urgent Care. The standards address the structural components of virtual care delivery, such as care coordination between clinical professionals and care settings, tracking outcomes, and identifying gaps and opportunities to improve. The standards are intended for…

On March 19, 2024, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new accountable care organization (ACO) model within the Medicare Shared Savings Program (MSSP) focused on nurturing team-based, person-centered primary care. The five-year model, called ACO Primary Care Flex, will provide a one-time advanced shared savings payment and monthly prospective…

On July 1, 2024, North Carolina Medicaid launched behavioral health Tailored Plans for beneficiaries with a serious mental illness (SMI), a serious emotional disturbance (SED), a severe addiction disorder, an intellectual/developmental disability (I/DD), or a traumatic brain injury (TBI). Enrollment, at 219,000 is 4.2% higher than the 210,000 that the North Carolina Department of Health…

Centene plans to exit the Medicare Advantage (MA) marketplace for 2025 in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island, and Vermont. This decision affects Centene’s Wellcare MA line. However, Wellcare will continue to offer Medicare Prescription Drug Plans (PDPs) in these states. The decision does not affect Centene’s Marketplace or Medicaid contracts in these…

Beginning October 1, 2024, UnitedHealth Group is launching a “gold card” program for provider organizations that are in-network for at least one UnitedHealth Group line of business. The goal of the program is to modernize and streamline the prior authorization process.  UnitedHealth said the program is intended to help physicians override prior authorization requirements to more quickly…