The explosive growth in Medicare Advantage (MA) enrollment over the last decade is significantly impacting providers' bottom lines. During a webinar presented on April 10, 2024, PYA's Martie Ross and Kathy Reep discussed regulations impacting MA plans and providers' interactions with the plans. Specifically, Martie and Kathy addressed these important points: 2025 MA rate announcement Prior authorization final rule Coverage criteria and utilization review regulations Impact of changes to the Centers for Medicare & Medicaid Services-HCC risk adjustment model MA enrollment and marketing restrictions Out-of-network payments for emergency services MedPAC report on MA reform The webinar was part of PYA's twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, one of our executives would be happy to assist. You may email them or call (800) 270-9629.

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