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) released its annual proposed rule updating the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2025....more
8/12/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Digital Health ,
Health Care Providers ,
Healthcare ,
Medicare ,
Mental Health ,
Physician Fee Schedule ,
Physicians ,
Telecommunications ,
Telehealth ,
Telemedicine
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
Since becoming aware of the cyberattack on Change Healthcare in late February, the Centers for Medicare & Medicaid Services (CMS) has announced a number of flexibilities to support affected providers that have experienced...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
On December 6, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed a rule—the Interoperability and Patient Access final rule—that introduces new requirements for health care payers aiming to enhance patient data...more
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
On January 30, the Centers for Medicare & Medicaid Services (CMS) released a long-awaited final rule addressing how it will calculate and collect overpayments from Medicare Advantage (MA) plans arising from risk adjustment...more
The Inflation Reduction Act of 2022 (IRA) includes the most dramatic change to U.S. drug price regulation in history. The new law allows the federal government to “negotiate” the price of many drugs dispensed to Medicare...more
9/7/2022
/ Biosimilars ,
Continuing Legal Education ,
Drug Pricing ,
Generic Drugs ,
Health Care Providers ,
Inflation Reduction Act (IRA) ,
Manufacturers ,
Medicaid ,
Medicare ,
Medicare Beneficiaries ,
Medicare Part D ,
New Regulations ,
Pharmaceutical Industry ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
Section 340B ,
Webinars
On August 16, President Joe Biden signed into law H.R. 5376 , the Inflation Reduction Act of 2022, which makes arguably the most significant changes to U.S. prescription drug price regulation ever, including by...more
On August 16, President Joe Biden signed into law H.R. 5376 , the Inflation Reduction Act of 2022, which makes arguably the most significant changes to U.S. prescription drug price regulation ever, including by...more
On August 16, President Joe Biden signed into law H.R. 5376, the Inflation Reduction Act of 2022, which makes arguably the most significant changes to U.S. prescription drug price regulation ever, including by...more
The Inflation Reduction Act (IRA) will make arguably the most significant changes to U.S. prescription drug pricing regulations ever, but certainly since the creation of the Medicaid Drug Rebate Program in 1990. For the first...more
8/18/2022
/ Continuing Legal Education ,
Drug Pricing ,
Health Care Providers ,
Inflation Reduction Act (IRA) ,
Medicare ,
Medicare Part D ,
Out-of-Pocket Expenses ,
Pharmaceutical Industry ,
Prescription Drugs ,
Rebates ,
Webinars ,
Wholesale
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
On January 12, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule,...more
1/25/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Drug Pricing ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Medicaid ,
Medical Loss Ratio ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
Prescription Drug Coverage ,
Prescription Drugs
Last month, the Center for Medicare and Medicaid Innovation (the Innovation Center, or CMMI) released its long-anticipated white paper, “Innovation Strategy Center Refresh,” outlining the Innovation Center’s strategic outlook...more
The Big Picture -
Until late December, few if any Medicare policy changes were anticipated as part of a year-end healthcare package, barring extensions of funding for programs that otherwise would have expired. But after...more
The Big Picture -
On March 18, 2020, the U.S. Senate passed—by a 90-8 vote—the Families First Coronavirus Response Act, a COVID-19 stimulus package. In addition to the healthcare provisions described below, which focus...more
3/20/2020
/ Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Economic Stimulus ,
Families First Coronavirus Response Act (FFCRA) ,
Financial Stimulus ,
Healthcare ,
Medicaid ,
Medical Testing ,
Medicare ,
Relief Measures ,
Telehealth
Earlier this year, the Department of Health and Human Services (HHS) announced a new Center for Medicare & Medicaid Innovation (CMMI) payment model for community paramedicine. Designed to reduce unnecessary use of emergency...more
Social determinants of health (SDOH) are conditions in the environments in which people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning, and quality-of-life outcomes and...more
Hospitals and Health Systems Prepare for a Value-Based Future -
Editor’s Note: Hospitals and health systems are actively working to service their communities in numerous ways, including through the adoption of initiatives...more
2/22/2018
/ Antitrust Division ,
Cost-Sharing ,
False Claims Act (FCA) ,
Hospitals ,
Information Sharing ,
Medicare ,
Medicare Part D ,
No-Poaching ,
Opioid ,
Pharmaceutical Industry ,
Physicians ,
Substance Abuse ,
Universal Health Services Inc v United States ex rel Escobar
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
1332 Waivers Under Review at CMS -
The Trump administration has approved one 1332 waiver to date, but four more are pending, including a sweeping Iowa waiver. Here is where things stand today...more