News & Analysis as of

Health Insurance New Guidance Centers for Medicare & Medicaid Services (CMS)

Mintz - Health Care Viewpoints

CMS Sheds Light on its Timeline for Expedited RADV Audits

Shortly following its announcement of sweeping changes to RADV audits, CMS shared industry guidance last week regarding upcoming deadlines for the submission of risk adjustment data corrections in advance of RADV sampling....more

McDermott+

Breaking Down the New No Surprises Act FAQs Post-TMA III

McDermott+ on

On January 14, 2025, the US Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), jointly issued Part 69 of a series of...more

McDermott Will & Schulte

CMS Releases Guidance on Coverage Criteria, Use of AI and 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

Bricker Graydon LLP

Departments Roll Back Enforcement Discretion in New Guidance on Transparency in Coverage Rules.

Bricker Graydon LLP on

Well, it was good while it lasted. On September 27th, the Departments issued new FAQs regarding implementation of provisions of The Transparency in Coverage Final Rules (TiC Final Rules). ...more

Verrill

Gag Clauses – New Guidance and Litigation Will Inform Compliance

Verrill on

Certain provisions of the Transparency in Coverage Final Regulations and the Consolidated Appropriation Act, 2021 (“CAA”) require group health plans and/or their vendors to report information to federal agencies. On December...more

Robinson & Cole LLP

Health Law Diagnosis - CMS Issues Guidance for Providers on Waivers, Flexibilities and End of COVID-19 Public Health Emergency

Robinson & Cole LLP on

The Centers for Medicare & Medicaid Services (CMS) recently issued a Fact Sheet (Fact Sheet) providing guidance on the impact of the end of the federal COVID-19 Public Health Emergency (PHE) on certain regulatory waivers,...more

Robinson+Cole Health Law Diagnosis

CMS Issues Guidance for Providers on Waivers, Flexibilities and End of COVID-19 Public Health Emergency

The Centers for Medicare & Medicaid Services (CMS) recently issued a Fact Sheet (Fact Sheet) providing guidance on the impact of the end of the federal COVID-19 Public Health Emergency (PHE) on certain regulatory waivers,...more

Husch Blackwell LLP

New Federal Guidance on Employer-Sponsored Group Health Plans and Required Action Steps for 2023

Husch Blackwell LLP on

The Consolidated Appropriations Act, 2021 (CAA) prohibits employer-sponsored group health plans from entering into agreements that contain so-called “gag clauses.” This prohibition generally restricts group health plans from...more

Nelson Mullins Riley & Scarborough LLP

CMS Releases New REH Conversion Guidance

The Centers for Medicare and Medicaid Services (“CMS”) recently released new guidance about the process for converting to a Rural Emergency Hospital (“REH”) – a new Medicaid provider type effective Jan. 1, 2023. REHs are...more

Sheppard Mullin Richter & Hampton LLP

CMS Issues Interprofessional Consultation Guidance

Introduction: Defining Interprofessional Consultation - In a January 5, 2023, letter to state health officials, the Centers for Medicare & Medicaid Services (“CMS”) clarified a Medicaid and Children’s Health Insurance...more

Brownstein Hyatt Farber Schreck

Health Plan Coverage of Coronavirus Testing and Treatment

With the news about the spread of the 2019 novel coronavirus (“COVID-19”) in the U.S. and the world rapidly evolving, group health plan sponsors need to address how the plan will provide virus-related benefits. ...more

Rivkin Radler LLP

CMS Issues Coronavirus Guidance

Rivkin Radler LLP on

Over the past week, the Centers for Medicare & Medicaid Services (CMS) has issued a flurry of guidance documents and FAQs regarding COVID-19 for healthcare providers in private practice, hospitals, nursing homes, hospices and...more

Bass, Berry & Sims PLC

CMS Guidance Paves Way for Medicaid Work Requirements

Bass, Berry & Sims PLC on

The Centers for Medicare & Medicaid Services (CMS) started the year with a bang, issuing guidance on January 11, 2018, in support of Medicaid demonstration projects that condition coverage on beneficiary participation in work...more

Foley & Lardner LLP

New Guidance Outlines Requirements for State Innovation Waivers

Foley & Lardner LLP on

New guidance from Centers for Medicare & Medicaid Services (CMS) places the spotlight on the ability of states to seek approval of “State Innovation Waivers” to test new approaches for delivering health insurance reform....more

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