Tricia Beckmann on Centers for Medicare & Medicaid Services (CMS)

Data Security Program, Medicare Advantage, Colorado Insurance Requirements & More

This month’s briefing covers DOJ’s approach to implementing its final rule on what’s now called the Data Security Program. The Trump administration also published a final rule on Medicare Advantage (MA), choosing not to...more

5/1/2025 / Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Colorado , Data Privacy , Data Security , Department of Justice (DOJ) , Final Rules , Medicare Advantage , Trump Administration

10-for-1 Deregulation Executive Order: Key Health Policy Issues to Watch

On January 31, 2025, President Trump signed Executive Order 14192 which is formally titled, “Unleashing Prosperity Through Deregulation,” but could gain notoriety as the “10 for 1 Order.” The Order has several parallels to a...more

2/12/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Deregulation , Executive Orders , Food and Drug Administration (FDA) , Healthcare , Medicaid , Medicare , Medicare Advantage , Regulatory Agenda

Assessing the Impact of a Revoked Executive Order on a Medicaid Drug Demonstration Project

Of the scores of day-one executive orders (EOs) issued by President Trump, the order rescinding a Biden administration executive order on lowering prescription drug costs is receiving much attention, given implications the...more

1/27/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Executive Orders , Health Insurance , Medicaid , Medicare , Pharmaceutical Industry , Prescription Drugs

Artificial Intelligence Briefing: Trump Names AI and Crypto Czar, and Other Regulatory, Legislative and Litigation Developments

This month we cover developments involving the Federal Trade Commission, the Centers for Medicare & Medicaid Services, the Financial Stability Board, the California Privacy Protection Agency, the Colorado Division of...more

12/12/2024 / Artificial Intelligence , California Privacy Protection Agency (CPPA) , Centers for Medicare & Medicaid Services (CMS) , Consumer Financial Protection Bureau (CFPB) , Fair Credit Reporting Act (FCRA) , Federal Trade Commission (FTC) , Financial Conduct Authority (FCA) , Medicare Advantage , NIST , Popular

Artificial Intelligence Briefing: House Launches Bipartisan AI Task Force

The House of Representatives aims to keep the U.S. at the leading edge of AI policy and innovation with a bipartisan task force while the FTC considers expanding a rule to crack down on AI impersonation. Meanwhile, a recent...more

2/23/2024 / Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Federal Trade Commission (FTC) , Food and Drug Administration (FDA) , Health Insurance , NAIC , Securities and Exchange Commission (SEC)

Federal Health Care Legislative Agenda: Fall Updates

As Congress returns and summer turns to fall, the federal health care legislative agenda remains crowded. While much near-term energy is focused on September 30 and averting a shutdown of the federal government before the...more

9/8/2023 / Centers for Medicare & Medicaid Services (CMS) , Continuing Resolution , Pharmaceutical Industry , Pharmacy Benefit Manager (PBM)

The Congressional Review Act: A Tool Democrats May Use to Overturn Recently Promulgated HHS Regulations

With Democrats having slight majorities in the House and Senate and Joe Biden in the White House, the Congressional Review Act (CRA) becomes an available tool to potentially vacate certain regulations that the outgoing Trump...more

1/20/2021 / Centers for Medicare & Medicaid Services (CMS) , Congressional Review Act , Department of Health and Human Services (HHS) , Trump Administration

Patient Engagement Tools and Supports: Analysis of the New Anti-Kickback Statute Regulatory Safe Harbor

Providers have a new tool in their toolbox to promote population health. The Health and Human Services Office of Inspector General (OIG) has adopted a new, extremely broad safe harbor that allows certain providers to give...more

12/3/2020 / ACOs , Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medical Devices , OIG , Pharmaceutical Industry , Pharmacy Benefit Manager (PBM) , Safe Harbors

CMS Proposes Reopening MLR Filings to Account for Risk Corridor Payouts

The Centers for Medicare & Medicaid Services (CMS) has issued guidance on how health insurers must report and rebate recoveries obtained from the federal government under the Supreme Court’s 8-1 decision in Maine Community...more

10/6/2020 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Medical Loss Ratio , Risk Corridors Statute

Regulatory Actions to Address Affordability of Coronavirus-Related Services

The federal government and many governors and state insurance regulators have taken recent actions in response to (or anticipation of) the spread of the coronavirus across communities in the United States. This document...more

3/17/2020 / Centers for Disease Control and Prevention (CDC) , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Savings Accounts , Infectious Diseases , NAIC , Public Health

New CMS Regulation Proposes Another Set of Plan-Friendly Tweaks to Medicare Advantage

On February 5, the Centers for Medicare and Medicaid Services (CMS) proposed several interesting tweaks to the Medicare Advantage (MA) and Medicare Part D programs through an 895-page proposed regulation, Contract Year 2021...more

2/12/2020 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage , Medicare Part D , Prescription Drugs

Is There a ‘Z’ in SDOH? New Government Report on Social Determinants of Health

Over the last five years, clinicians, health plans and policymakers have ramped up their focus on the social determinants of health (SDOH). SDOH are non-medical factors (food security, housing security, reliable access to...more

1/29/2020 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Medicare , Physicians

The Pronounced Importance of an Unpronounceable Acronym: New Guidance on SSBCI in Medicare Advantage

On April 24, Centers for Medicare and Medicaid Services (CMS) issued a memo to Medicare Advantage (MA) plan sponsors detailing the scope of Special Supplemental Benefits for the Chronically Ill (SSBCI). Established by the...more

4/26/2019 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage

CMS Announces Primary Cares Initiative: New Direction or New Messaging?

On April 22, The Center for Medicare and Medicaid Innovation (the Innovation Center) at the Centers for Medicare and Medicaid Services (CMS) announced a new Primary Cares Initiative, with two new payment models aimed at...more

4/24/2019 / Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Value-Based Care

Medicare Advantage Plan Adoption of New Flex Benefits in 2019

Medicare Advantage, the private plan option in the Medicare program, is growing rapidly. Currently, 22 million people choose Medicare Advantage — more than one third of people with Medicare — and that number is expected to...more

1/25/2019 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage

Trick or Treat? Expected and Surprising Provisions in the New Medicare Advantage Regulation

On October 26, the Centers for Medicare and Medicaid Services (CMS) released a 362-page proposed regulation that makes changes to three expected areas: - New telehealth flexibilities for Medicare Advantage (MA) plans....more

11/2/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage , Medicare Part D , Proposed Regulation

Requiring a Price Tag in Drug Commercials: Furthering Consumer Transparency or Government Overreach?

The Trump Administration released a draft regulation published in the Federal Register on October 18, 2018, which proposes to require drug manufacturers to include a drug’s list price in its direct-to-consumer (DTC)...more

10/19/2018 / Advertising , Centers for Medicare & Medicaid Services (CMS) , Comment Period , Department of Health and Human Services (HHS) , Direct to Consumer Sales , Pharmaceutical Industry , Prescription Drugs , Television Commercials , Trump Administration

CMS Greenlights Indication-Based Formulary Design: What Do You Need to Know?

In its latest effort to implement the Trump administration’s plan to address concerns over the cost of drugs, the Centers for Medicare and Medicaid Services (CMS) announced that Part D drug plans can begin applying...more

9/7/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Part D , Prescription Drug Coverage , Prescription Drugs

‘Text Me Your Symptoms’: CMS Proposes Expanding Coverage for Digital Health Services

In what can only be described as “out of the box” thinking, the Centers for Medicare and Medicaid Services (CMS) is proposing to pay physicians for virtual check-ins, and for asynchronous interactions with patients in which...more

7/30/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians , Telehealth

A New Advantage in Medicare: New Benefit Flexibilities Will Change Medicare Advantage

A provision included in the recently enacted budget law will now make it much easier for Medicare Advantage (MA) plans to offer a wide array of supplemental benefits within their plans. This will create new opportunities for...more

2/14/2018 / Beneficiaries , Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage

A Step Toward ‘Replace' Without the ‘Repeal': The Trump Administration Re-Regulates Obamacare

On Friday, October 27, the Centers for Medicare and Medicaid Services (CMS) published its draft annual Proposed Notice of Benefits and Payment Parameters for Calendar Year 2019. This proposal follows on the heels of a Request...more

11/3/2017 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Essential Health Benefits , Health Insurance , Qualified Health Plans , Repeal , Trump Administration

A Cautious First Step From a Bold Administration: Proposed Rule on Clinician Quality-based Payments Incorporates Some, But Not...

On June 30, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule covering the second and future years of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program. The...more

7/3/2017 / Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare Access and CHIP Reauthorization (MACRA) , MedPAC , MIPS

An Unsettling Settlement: Health Plan to Pay $32 Million to Settle Coding and Provider Network Misrepresentation Charge

On May 30, the Department of Justice (DOJ) announced that it reached a settlement with commonly-owned Freedom Health Inc. and Optimum Healthcare, Inc. (Freedom Health) — two Tampa, Florida, managed care plans — to settle...more

6/6/2017 / Centers for Medicare & Medicaid Services (CMS) , Department of Justice (DOJ) , False Claims Act (FCA) , Health Care Providers , Medicare Advantage

Market Stabilization Rule: Assessing the Trump Administration's First ACA Market-Related Regulation

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized its Marketplace Stabilization Rule. This is the first Trump administration regulation that applies to the health insurance markets remade by...more

4/25/2017 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Trump Administration

Tricia Beckmann

Faegre Drinker Biddle & Reath LLP

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