Erin Estey Hertzog on Medicare

CMS Releases Request for Information on Medicare Advantage Data

On January 30, 2024, CMS published in the Federal Register an RFI to seek input from the public regarding increased public releases of MA data to improve transparency in the program. CMS stated responses to this RFI may be...more

1/31/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Managed Care Contracts , Medicaid , Medicare , Medicare Advantage , Public Comment , Request For Information

CMS Identifies First 10 Drugs for Medicare Price Negotiation

This morning the Centers for Medicare & Medicaid Services (CMS) published, for the first time, a list of drugs subject to price negotiation under the Inflation Reduction Act’s (IRA) Medicare Drug Price Negotiation program....more

8/30/2023 / Biosimilars , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Inflation Reduction Act (IRA) , Medicare , Medicare Part D , Negotiations

CMMI Announces Medicare Dementia Care Model

The GUIDE Model is an eight-year model that will test an alternative payment for participants that delivers key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans,...more

8/4/2023 / Biden Administration , Caregivers , Centers for Medicare & Medicaid Services (CMS) , Dementia , Executive Orders , Health Care Providers , Healthcare , Healthcare Reform , Long-Term Care , Medicare , New Guidance

CMMI Introduces New Multi-State Initiative Focused on Enhancing Primary Care Delivery

CMMI was established to test innovative payment and service delivery models expected to reduce expenditures and preserve or enhance care quality under Medicare, Medicaid, and the Children’s Health Insurance Program. Over the...more

6/13/2023 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , CMMI , Health Insurance , Healthcare , Medicaid , Medicare , Value-Based Care

Medicare Drug Price Negotiation Program Initial Guidance

On March 15, 2023, the Centers for Medicare & Medicaid Services (CMS) issued an initial guidance regarding the Medicare Drug Price Negotiation Program (Negotiation Program) established by the Inflation Reduction Act of 2022...more

3/31/2023 / Biosimilars , Centers for Medicare & Medicaid Services (CMS) , Compliance , Drug Pricing , Food and Drug Administration (FDA) , Inflation Reduction Act (IRA) , Medicare , Negotiations , New Guidance , Section 340B

HHS Issues Report Outlining Three New Drug Models for Testing by CMMI

On February 14, 2023, and in response to Executive Order 14087 (“Lowering Prescription Drug Costs for Americans”), the Secretary of Health and Human Services (HHS) issued a report announcing the selection of three models that...more

2/22/2023 / Centers for Medicare & Medicaid Services (CMS) , CMMI , Department of Health and Human Services (HHS) , Drug Pricing , Fee-for-Service , Food and Drug Administration (FDA) , Inflation Reduction Act (IRA) , Medicaid , Medicare , Medicare Part B , Medicare Part D

OIG Technical Assistance on Part B Inflation Rebates Implementation Barriers and CMS’ Proposed Solutions in Recent Part B...

On February 7, 2023, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published a report entitled, “Technical Assistance Brief: Implementation of Inflation-Indexed Rebates for Part B Drugs.” ...more

2/17/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Drug Pricing , Inflation Reduction Act (IRA) , Medicaid Drug Rebate Program , Medicare , Medicare Part B , OIG

6/28/2022 / Becerra Secretary Of Health And Human Services v Empire Health Foundation For Valley Hospital Medical Center , Chevron v NRDC , Department of Health and Human Services (HHS) , Disproportionate Share Adjustments , Hospitals , Medicaid Reimbursements , Medicare , Patients , SCOTUS

Erin Estey Hertzog

Foley Hoag LLP

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