Mary Moll Alexandre

Mary Moll Alexandre

McDermott Will & Schulte

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Food as Medicine: A Deep Dive Into Reimbursement

The topic of “food as medicine” has gained increased attention recently, driven by a growing recognition of the role nutrition plays in preventing and managing chronic diseases. This article provides a high-level overview of...more

5/2/2025  /  Centers for Medicare & Medicaid Services (CMS) , Employer Group Health Plans , Government Agencies , Health Insurance , Medicaid , Medicare , Medicare Advantage , Regulatory Requirements , Reimbursements

Administration Offers Up New Proposals to Cut Drug Costs

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

12/3/2018  /  Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Life Sciences , Medicaid , Medicare Advantage , Medicare Part B , Medicare Part D , Pharmaceutical Industry

Final Policies on Encounter Data and the Star Ratings Released

The Centers for Medicare and Medicaid Services recently finalized meaningful Medicare Advantage policy changes in response to industry concerns, including those regarding data integrity, the Star Ratings and encounter data....more

4/6/2017  /  Centers for Medicare & Medicaid Services (CMS) , Data Collection , Medicaid , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Risk Adjustment Formula , Star Ratings

Medicare Advantage Draft Call Letter Addresses Encounter Data, Star Ratings

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

2/8/2017  /  Centers for Medicare & Medicaid Services (CMS) , Enforcement , Medicaid , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D

CMS’s Final Medicaid Rule Creates a Medicaid MLR Framework but Leaves Room for State Variation

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

5/12/2016  /  Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Managed Care Contracts , Medicaid , Medical Loss Ratio

MA Changes Shift Funding and Add Uncertainty to Already Complex Payment Methodologies

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

5/4/2016  /  Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Advantage , Payment Methods , Provider Payments
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