Tara Dwyer on Centers for Medicare & Medicaid Services (CMS)

CMS Releases CY 2019 Proposed Rule for Medicare Advantage and Part D

Last Thursday, November 17, 2017, the Centers for Medicare & Medicaid Services (CMS) released its proposed contract year 2019 Medicare Advantage and Part D regulations. The proposed rule is scheduled to be published in the...more

11/21/2017 / Centers for Medicare & Medicaid Services (CMS) , Comprehensive Addiction and Recovery Act of 2016 (CARA) , Generic Drugs , Medicaid , Medicare , Medicare Advantage , Medicare Part D , Pharmaceutical Industry , Prescription Drugs , Proposed Rules

CMS Completes Final Medicare Part D Reconciliation for 2016

CMS has completed the 2016 Final Part D Payment Reconciliation. Each Medicare Part D plan sponsor’s reconciliation reports will be available on October 12, 2017....more

10/12/2017 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Health Plan Sponsors , Medicare Part D , Pharmacies , Prescription Drugs , Remuneration , Reporting Requirements

CMS Releases the Final Medicare Part D DIR Reporting Requirements for 2016

On Friday, June 23, 2017, CMS released the Final Medicare Part D DIR Reporting Requirements for 2016. Part D sponsors may begin submitting their DIR information on June 30, 2017 and must finish their submissions by the end of...more

6/26/2017 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Medicare Part D , Pharmacies , Proposed Regulation , Provider Payments , Remuneration , Reporting Requirements

CMS Releases the Proposed Part D DIR Reporting Requirements for 2016

Yesterday, CMS released the Proposed Part D DIR (Direct and Indirect Remuneration) Reporting Requirements for 2016 and postponed the 2016 DIR Reporting deadline....more

5/18/2017 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Medicare Part D , Proposed Regulation , Provider Payments , Remuneration , Reporting Requirements

Revised Draft 2018 Medicare Marketing Guidelines Open For Comment

Last week, CMS published the Revised Draft 2018 Medicare Marketing Guidelines and requested feedback from all interested parties. The draft includes many small changes to the Marketing Guidelines, including but not...more

1/26/2017 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Electronic Communications , Health Plan Sponsors , Medicare , Section 1557

2017 MA and Part D Audit Protocols and Data Requests are Open for Comment

CMS issued its Audit Protocols and Data Requests for Medicare Advantage and Part D plans on November 4, 2016 (the “Protocols”). The Protocols have been updated based on the over 500 comments CMS received in response to the...more

11/14/2016 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage , Medicare Part D

Senate Bill Targets Part D DIR Fees

Just last month the “Improving Transparency and Accuracy in Medicare Part D Spending Act” was introduced in the Senate to amend the Social Security Act. The bill seeks to prohibit Part D plans (and their contracted pharmacy...more

10/12/2016 / Centers for Medicare & Medicaid Services (CMS) , Medicare Part D , Pharmacies , Point of Sale Terminals , Remuneration , Social Security Act , Transparency

2018 Notice of Benefits and Payment: Proposed Updates to the HHS Risk Adjustment Model

Last week, the Centers for Medicare & Medicaid Services (“CMS”) released its 2018 Notice of Benefit and Payment setting out payment parameters for the Health Insurance Marketplace for upcoming years. With several insurers...more

9/8/2016 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Prescription Drug Coverage , Prescription Drugs

Part D Woes, According to the OIG

On June 23, 2015, the OIG issued two reports focusing on fraud, waste, and abuse in the Part D program, the first “Ensuring the Integrity of Medicare Part D” and the second “Questionable Billing Practices and Geographic...more

7/2/2015 / Centers for Medicare & Medicaid Services (CMS) , Fraud Alerts , Healthcare , Medicare , Medicare Part D , OIG , Prescription Drug Coverage , Prescription Drugs

CMS Changes Medicare Prescriber Enrollment Requirements

On May 6, 2015, CMS issued interim final rules relating to Medicare Part D beneficiary access to Part D drugs. Through the rules, CMS announced updates regarding the impending prescriber enroll or opt-out effective date,...more

5/15/2015 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare , Medicare , Medicare Part D , Prescription Drugs , Proposed Regulation

MA Risk Adjustment in the 2016 Call Letter and … in Health Care Fraud Charges

In past Call Letters, CMS has proposed and finalized significant changes to the Medicare Advantage risk adjustment system including, recalibrations, deletions and additions of diagnoses codes, and questioning of the value of...more

3/6/2015 / Centers for Medicare & Medicaid Services (CMS) , Coding , Healthcare , Healthcare Fraud , Medicare , Medicare Advantage

CMS Releases 2016 Draft Call Letter

Last week, the Centers for Medicare & Medicaid (CMS) released its 2016 Advance Rate Notice and draft Call Letter (2016 Call Letter) for the Medicare Advantage (MA) and Medicare Part D programs. The 2016 Call Letter outlines...more

2/27/2015 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage , Medicare Part D , Pharmaceutical Industry , Pharmacies , Physician Medicare Reimbursements

CMS Issues Rewards and Incentive Guidance to MA Plans

On December 4, 2014, CMS issued additional guidance regarding rewards and incentives programs (“RI Programs”). This guidance elaborates on whether an RI Program can target members with specific diseases, whether rewards can...more

12/19/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Incentives , New Guidance

Front End Changes and, Again, More DIR Columns

Since the beginning of the Medicare Part D program, CMS has introduced many reporting mechanisms for trying to understand drug pricing, price concessions, and the cost of providing services to Part D members. The tool CMS...more

10/20/2014 / Centers for Medicare & Medicaid Services (CMS) , Health Plan Sponsors , Healthcare , Hospitals , Medicare Part D , Pharmaceutical Industry , Pharmacies , Prescription Drug Coverage , Prescription Drugs , Reporting Requirements

CMS Continues to Struggle with How to Provide High Quality Care to Dual Eligibles

Last week CMS announced that it would not execute its option to terminate its 2015 contracts with Medicare Advantage Plans and Part D plans that had scored three stars or less for three consecutive years. ...more

9/22/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Medicare , Medicare Advantage , Medicare Part D

CMS Proposes Major Changes to Medicare Parts C and D

On January 10, the Centers for Medicare & Medicaid Services (CMS) published proposed rules labeled as “policy and technical” changes to the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) Programs....more

1/22/2014 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Part C , Medicare Part D

2014 Final Call Letter: CMS Raises Medicare Advantage Rates but Foreshadows Other Significant Program Changes

After receiving many comments on its Draft Call Letter, CMS published its Contract Year 2014 Final Call Letter on April 1, 2013. The Final Call Letter addresses a wide variety of issues that will affect all parties involved...more

4/17/2013 / Beneficiaries , Centers for Medicare & Medicaid Services (CMS) , Controlled Substances , Medical Reimbursement Plans , Medicare Advantage , Modification , Pharmacies , Point of Sale Terminals , Prescription Drugs , Waivers

CMS Publishes 2014 Final Call Letter

Yesterday, CMS released its 2014 Final Call Letter for the Medicare Advantage and Medicare Part D programs....more

4/2/2013 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage , Medicare Part D

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