CMS has officially appealed the federal court ruling that struck down its 2023 RADV Final Rule, reaffirming the agency’s commitment to defend extrapolation as a central tool in Medicare Advantage oversight. On Nov. 21, the Department of Justice filed a notice of appeal in Humana Inc. v. Kennedy to the Fifth Circuit Court of Appeals. The lower court had vacated the RADV rule on procedural grounds, finding CMS violated the Administrative Procedure Act by shifting its legal jus

Review CMS’ 2026 CAHPS updates and learn what health plans should prioritize now. Key deadlines, survey changes, strategy focus areas, and how Rebellis can help

CMS just issued its 2026 Program Audit Annual Update , and there are several major shifts  that Medicare Advantage, Part D, and Cost Plans should begin preparing for now. Below are the key takeaways: 1. Audit Scoring Is Eliminated CMS is removing all audit scoring beginning in 2026. Conditions will no longer carry points , and CMS may consider alternative weighting methods in the future. 2. Condition Classifications Are Simplified CMS is retiring ICAR and ORCA categories.

The White House recently announced deals with Eli Lilly and Novo Nordisk to reduce pricing on GLP-1 medications. Medicare beneficiaries will pay no more than $50 per month  for approved treatments like Zepbound and Ozempic. In this announcement, the White House stated Ozempic, Wegovy, Mounjaro and Zepbound Medicare program costs will drop to $245, a significant reduction from current prices, without rebate considerations. Eli Lilly cites copay caps to start as early as Apri