Mary Moll Alexandre on Medicare

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

CMS Proposes to Prohibit Overrides in Medicare Advantage

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

11/10/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Managed Care Contracts , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D , Proposed Rules

CMS Issues Medicare Drug Price Negotiation Initial Guidance, First Inflation Rebate List

On March 15, 2023, the Centers for Medicare and Medicaid Services (CMS) issued initial program guidance related to implementation of the Medicare Drug Price Negotiation Program. CMS requested public comments on selected...more

4/5/2023 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Inflation Reduction Act (IRA) , Medicare , Medicare Part B , New Guidance

Flurry of Medicare Advantage and Part D Changes Includes Significant Policy Shifts

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

4/13/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage Organizations (MAOs) , Medicare Part D

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

21st Century Cures: A Closer Look

On December 7, 2016, the US Congress enacted the 21st Century Cures Act, substantial legislation intended to accelerate “discovery, development and delivery” of medical therapies by encouraging biomedical research investment,...more

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

Mary Moll Alexandre

McDermott Will & Schulte

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