On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website), which aims to improve prior...more
1/26/2024
/ Application Programming Interface (APIs) ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Denial of Insurance Coverage ,
Federally Facilitated Exchanges ,
Final Rules ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medicaid ,
Medicare Advantage ,
MIPS ,
Patients ,
Qualified Health Plans ,
Single-Payer
During this session, Partner Jeremy Earl moderated a panel that discussed how value-based care models are delivering care to individuals with complex conditions and those with significant healthcare and social needs. The...more
On November 26, CMS released a notice of proposed rulemaking, “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses,” which includes provisions that aim to reduce overall drug...more
The Centers for Medicare & Medicaid Services recently announced that, in a reversal of prior policy, it will begin to allow Medicare Advantage organizations (MAOs) to implement step therapy for Part B drugs and services as of...more
In an effort to stabilize the Exchanges and encourage issuer participation, the Centers for Medicare & Medicaid Services (CMS) recently extended the federal Exchange application and rate filing deadlines and published a...more
2/27/2017
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
De Minimis Claims ,
Department of Health and Human Services (HHS) ,
Enrollment ,
Executive Orders ,
Filing Deadlines ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Open Enrollment ,
Proposed Rules ,
Qualified Health Plans ,
Trump Administration
In Depth -
The final Medicaid managed care rule issued by the Centers for Medicare & Medicaid Services (CMS) on April 25, 2016, (the Final Rule) establishes a new federal medical loss ratio (MLR) standard for Medicaid...more
States would have the option to create binding Medicaid MLR requirements modeled after existing commercial market MLR standards.
This article is part of a series that takes an in-depth look at several proposals that...more
The Centers for Medicare & Medicaid Services proposes significant changes to several key Medicare Part D Program components, such as the “any willing pharmacy” contracting requirement, that will affect all industry...more
On February 15, 2013, the Centers for Medicare & Medicaid Services released for comment two key documents affecting the Medicare Advantage (MA) and Part D Programs: (1) the Advance Notice of Methodological Changes for...more
The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced the health care organizations chosen to participate in the Bundled Payments for Care Improvement (BCPI) Initiative. The BCPI Initiative represents a...more