The Centers for Medicare & Medicaid Services (CMS) released the Part D national average bid amount and Part D base beneficiary premiums for 2025. These figures set the premium costs and government subsidies for Medicare...more
The Centers for Medicare & Medicaid Services (CMS) finalized the second part of its guidance on implementation of the IRA’s Medicare Prescription Payment Plan (MPPP), known informally as Part D monthly out of-pocket...more
The Center for Medicare and Medicaid Innovation (CMMI) has provided new updates on CMS’ planned initiatives to address prescription drug costs in a blog post from Director Liz Fowler. One test, the Accelerating Clinical...more
10/31/2023
/ CMMI ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Life Sciences ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
Pharmaceutical Industry ,
Prescription Drugs
Medicare Advantage (MA) plans now cover about half of Medicare beneficiaries, and with that enrollment growth has come increased scrutiny from federal and state regulators. As federal regulators complete a busy season of...more
3/28/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Continuing Legal Education ,
Enforcement ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Medical Necessity ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Medicare Beneficiaries ,
New Rules ,
Risk Adjustment Formula ,
Webinars
Americans are strongly focused on the upcoming midterm elections. An NBC News survey shows that 68% of Republicans and 66% of Democrats are expressing high interest in the midterms. Which issues are most critical to voters...more
9/26/2022
/ Abortion ,
Health Care Providers ,
Health Insurance ,
Healthcare Costs ,
Healthcare Reform ,
Legislative Agendas ,
Prescription Drugs ,
Regulatory Agenda ,
Reproductive Healthcare Issues ,
State Elections ,
Webinars
In-home evaluations (IHEs) are an integral component of Medicare Advantage (MA) plans, giving MA plans a cost-effective way to identify and meet the medical and nonmedical needs of vulnerable beneficiaries in their own homes...more
In December 2021, the Centers for Medicare & Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters for 2023. This proposal kicks off the annual rulemaking cycle for the Marketplaces and the...more
Executive Summary -
Employers sponsoring group health plans face the ever-growing challenge of rising health care costs, and the increasing expenses they place on the plans and their enrollees alike. To respond to these...more
On October 27, 2017, the Department of Health and Human Services (HHS) released its annual proposed Notice of Benefit and Payment Parameters, containing proposed changes to the regulation of the individual and small group...more
Using Telehealth as a Tool for Health System Integration -
As discussed in our August Health Update article on patient engagement and digital health—the first in our new digital health series—the advent of digital and...more
Next Steps on Healthcare Reform -
Though President Trump has continued to call for action on repeal and replace in the wake of the Senate’s failed vote at the end of July, congressional Republicans have been fairly muted...more
8/8/2017
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Cost-Sharing ,
DSH ,
Health Insurance ,
Healthcare Reform ,
HOPPS ,
Pharmaceutical Industry ,
Repeal ,
Section 340B ,
Tax Reform ,
Waivers
On July 11, the federal government announced approval of Alaska’s waiver request under Section 1332 of the Patient Protection and Affordable Care Act for funding in support of the Alaska Reinsurance Program (ARP). The ARP is...more
Overview -
On June 12, Iowa submitted a sweeping Section 1332 waiver that would replace the Affordable Care Act’s (ACA) premium tax credits with a new state-administered tax credit and a reinsurance program. The state tax...more