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LATEST INDUSTRY UPDATES
April, 2025
Federal Communications Pause: CMS Hasn’t Updated Appeals Decisions Since Jan. 20
On January 22, the Department of Health and Human Services was instructed to pause non-essential public communications and website updates. Though framed as a temporary, precautionary measure, this pause has real-world ripple effects on tools that many health plans rely on, including the CMS Appeals Decision Search tool for Part C and Part D. The search tool has not been updated since January 20; unless filtered by date, the lack of updates may go unnoticed—creating a false sense that the data is current.
Read on for best practice tips on how plans can incorporate independent review entity decisions into the internal review process.
Recommendations for Medicare Advantage Plans
- Continue using Appeals Decision Search while clearly labeling its current limitations
- Monitor HPMS memos and CMS newsletters closely—they may include updates that aren't on public websites
- Stay alert for coverage or operational guidance related to 2026
- Supplement decision research with internal appeal outcome tracking and cross-plan benchmarking
ATTAC On The Road
Medicare Market Innovations Forum | May 14-15 | Scottsdale
Join Charles Baker, ATTAC's VP for Compliance Solutions, for the panel, Responding to the Potential for an Increased Shopping Rate During the AEP: Strategies to Stand Out in a Crowded and Noisy Market
Medicare Stars, HEDIS®, Quality & Risk Summit June 3-5 | Chicago
Subbu Ramalingam, ATTAC Managing Director, will join the panel, Strategies to Improve Performance Scores in the Face of Fierce Competition, Regulatory Uncertainty, Financial Challenges, and Changing Demographics
