✦ UnitedHealth Group will reprocess all of its commercial claims for COVID-19 vaccine administration after a federal investigation found the integrated health care giant paid providers less than 40% of the Medicare reimbursement rate for administering inoculations. Sen. Bob Casey, Jr. (D-Pa.), chair of the special committee on aging, wrote in a letter to UnitedHealth that it must inform the committee of the number of claims it expects to reprocess by Nov. 5. UnitedHealth will owe about $15 million for every 1 million claims it reprocesses, according to press reports.
✦ CMS has given itself another year to finalize a proposal to begin using an extrapolation methodology in recovering overpayments from Medicare Advantage organizations. The Trump administration in a November 2018 proposed rule (83 Fed. Reg. 54982, Nov. 1, 2018) said it planned to extrapolate the results of Risk Adjustment Data Validation Audits, starting with 2011 contract-level audits, and not apply a “fee-for-service adjuster” to account for inaccurate diagnosis codes in FFS Medicare data used to calibrate the MA risk adjustment model.
✦ CMS for the first time on Oct. 12 approved a state’s request to provide gender-affirming care as an essential health benefit (EHB) in the individual and small-group health insurance markets. Colorado’s new EHB-benchmark plan will offer transgender individuals access to a wider range of services than what is currently covered by their health plans, such as eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions, and laser hair removal. Effective Jan. 1, 2023, Colorado is also adding EHBs in its benchmark plan to include mental wellness exams and expanded coverage for 14 prescription drug classes.
✦ A pharmacy trade group made a formal request to the Dept. of Justice, asking that the government block UnitedHealth Group’s proposed acquisition of Change Healthcare Inc. “This deal would give UHG a trove of intelligence on its smaller competitors, including thousands of independent pharmacies and their patients.