Bridgette Keller on Centers for Medicare & Medicaid Services (CMS)

New Rules for ACOs in the MSSP

CMS issued a final rule, published in the Federal Register on Friday, June 10, 2016, updating how the performance of ACOs participating in the Medicare Shared Savings Program (MSSP) is measured and compensated. This rule is...more

6/16/2016 / ACOs , Benchmarking , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Shared Savings Program

Delay in Final Rule Implementing PAMA: Sunshine Act Revisited?

As reported in our 2015 Laboratory Industry Year in Review post, the laboratory industry began 2016 amid confusion regarding how to comply with the Protecting Access to Medicare Act of 2014 (PAMA), which made the most...more

3/31/2016 / Centers for Medicare & Medicaid Services (CMS) , Clinical Laboratory Testing , Final Rules , PAMA , Sunshine Act

CMS Releases 2017 Advance Notice and Draft Call Letter

Last week, the Centers for Medicare & Medicaid Services (CMS) released its 2017 Advance Rate Notice and draft Call Letter (“2017 Draft Call Letter”) for the Medicare Advantage (“MA”) and Part D programs. With the final 2017...more

3/1/2016 / Centers for Medicare & Medicaid Services (CMS) , Employer Group Health Plans , Medicare Advantage , Medicare Part D , Prescription Drugs , Star Ratings , Substance Abuse , Waivers

Groundbreaking Multi-Payer Alignment on Core Measures for Quality-Based Payments

For too long, health industry stakeholders have bandied about massive amounts of information that could not be used in a comparative sense. Both public and private payers had their own proprietary reporting metrics,...more

2/24/2016 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicaid , Proprietary Information , Provider Payments , Quality of Care Standards

HRSA Takes its First Steps on 340B Rules

The 340B Drug Discount Program has operated for more than 20 years with just a few governing regulations codified in 42 CFR Part 10. Through the Affordable Care Act (“ACA”), Congress adopted several amendments to the 340B...more

6/23/2015 / Centers for Medicare & Medicaid Services (CMS) , Civil Monetary Penalty , Drug Pricing , HRSA , Medicaid , Pharmaceutical Industry , Prescription Drugs , Section 340B

Over a Decade in the Making: CMS Releases Long-Awaited Medicaid Managed Care Rule

On May 27, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published a 653-page proposed rule affecting the thirty-nine states (plus the District of Columbia) that use managed care organizations (“MCOs”) to...more

6/8/2015 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Managed Care Contracts , Medicaid

CMS Call Letter: Medicare Advantage Contracting Considerations

As a final addition to our series on the 2016 Draft Call Letter, we highlight some of the MA contracting issues raised by the Centers for Medicaid and Medicare Services (“CMS”). Specifically, CMS (1) recommends Medicare...more

3/9/2015 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Managed Care Contracts , Medicare , Medicare Advantage

CMS Finalizes Policy Rules For Medicare Parts C and D

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its final rules on policy and technical changes to the Medicare Advantage (MA) and Prescription Drug Benefit programs (Part D) for contract year...more

2/17/2015 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Healthcare , Medicare , Medicare Advantage , Medicare Part C , Medicare Part D

CMS Issues Rewards and Incentive Guidance to MA Plans

On December 4, 2014, CMS issued additional guidance regarding rewards and incentives programs (“RI Programs”). This guidance elaborates on whether an RI Program can target members with specific diseases, whether rewards can...more

12/19/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Incentives , New Guidance

CMS Proposes Major Changes to Medicare Parts C and D

On January 10, the Centers for Medicare & Medicaid Services (CMS) published proposed rules labeled as “policy and technical” changes to the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) Programs....more

1/22/2014 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Part C , Medicare Part D

Bridgette Keller

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