On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule and press release revising the regulations governing the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program,...more
On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) related to Medicare Advantage (MA) coverage criteria and utilization management (UM) requirements....more
On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding Contract Year (CY) 2025 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug...more
On January 6, 2022, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit...more
The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a Letter of Interest (LOI) for a new geographic model option within the Direct Contracting portfolio. The geographic model would transfer full...more
Hospitals and health systems are facing consumer demand for innovation, the need to expand and enhance streams of revenue and the push for improved quality, all while navigating changing regulations, federal enforcement,...more
2/6/2020
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The Centers for Medicare and Medicaid Services (CMS) recently released several significant Medicare Advantage (MA) and Part D guidance documents outlining new Center for Medicare and Medicaid Innovation (CMMI) programs and...more
2/8/2019
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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
On October 26, 2018, CMS released a Notice of Proposed Rulemaking addressing expanded telehealth coverage in Medicare Advantage, extrapolation of RADV audit results, and updates to the Medicare Advantage and Part D Quality...more
The other payer advanced alternative payment model (APM) option is intended to give eligible clinicians an additional option to meet MACRA’s escalating participation thresholds to qualify for the 5 percent advanced APM bonus....more
Last week, CMS released new regulations and guidance for Medicare Advantage Organizations (MAOs) and Part D Sponsors. These documents—along with the Bipartisan Budget Act of 2018 that was passed in January—reflect significant...more
The Centers for Medicare & Medicaid Services (CMS) has released its annual payment and policy guidance for Medicare Advantage and Part D plans. CMS is continuing to find ways to inject more flexibility into these programs,...more
CMS released a broad-ranging proposed rule for the Medicare Advantage and Part D Programs on Thursday, November 16, 2017. The proposed rule addresses a broad and diverse range of MA and Part D regulatory requirements,...more
On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released proposed updates to the Medicare Advantage (MA) and Part D programs through the CY 2018 Advance Notice and Draft Call Letter. Despite largely...more
The 21st Century Cures Act encourages biomedical research investment and facilitates innovation review and approval processes, but also serves as a vehicle for a wide variety of other health-related measures, including...more
In Depth -
The Medicare Physician Fee Schedule proposed rule released by the Centers for Medicare & Medicaid Services (CMS) on July 7, 2016, (the Proposed Rule) requires certain providers and suppliers furnishing health...more
7/26/2016
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Prescription Drug Coverage
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
In Depth -
On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding updates to fiscal year (FY) 2017 Medicare payment rates and the wage index for hospices serving Medicare...more
In Depth -
The Centers for Medicare & Medicaid Services has enacted significant changes to Medicare Advantage (MA) payment methodologies that will shift payment towards MA organizations (MAOs) enrolling significant...more
More than a year ago, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed significant regulatory changes to the Medicare Advantage (MA) and Part D Programs, many of which were the subject of significant...more
The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year (CY) 2017. The...more
The United States Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) published its update to the home health prospective payment system (HHPPS) for fiscal year (FY) 2016 in the August...more
CMS seeks to impose more rigorous program integrity requirements for contractors and states.
This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations,...more
More than a year ago, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed significant regulatory changes to the Medicare Advantage (MA) and Part D Programs, many of which were the subject of significant...more
Acknowledging concerns regarding some proposals in the January 2014 proposed rule for the Medicare Advantage and Part D Programs, the Centers for Medicare & Medicaid Services states it does “not plan to finalize” certain...more