Ankur Goel on Medicare Advantage

Top Takeaways | Risk-Adjustment Roulette: Strategies for Navigating the Shifting Landscape

McDermott Will & Emery Partner Ankur Goel moderated a panel during the Value-Based Care Symposium that focused on the risk-adjustment landscape and provided insights into how the regulatory environment and contractual...more

5/26/2023 / Centers for Medicare & Medicaid Services (CMS) , Collaboration , Department of Health and Human Services (HHS) , False Claims Act (FCA) , Health Care Providers , Healthcare , Investment , Investors , Medicare Advantage , Medicare Advantage Organizations (MAOs) , OIG , Physicians , Professional Conferences , Risk Adjustment Formula , Value-Based Care

CMS Finalizes Risk Adjustment Model in 2024 Rate Announcement for Medicare Advantage and Part D

On March 31, 2023, the US Centers for Medicare & Medicaid Services (CMS) issued its Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, otherwise known as...more

4/5/2023 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part C , Medicare Part D

CMS Releases the CY 2024 Advance Notice for Medicare Advantage and Part D

On February 1, 2023, the US Centers for Medicare & Medicaid Services (CMS) released the Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and Part C and D...more

2/9/2023 / Billing Rates , Centers for Medicare & Medicaid Services (CMS) , Cost-Sharing , ESRD , Inflation Reduction Act (IRA) , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part C , Medicare Part D , Notice Requirements , Provider Payments , Restructuring , Trusts

CMS Issues Broad-Ranging Medicare Advantage and Part D Proposed Rule

On December 14, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding Contract Year 2024 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit...more

1/6/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Managed Care Contracts , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D , Pharmaceutical Industry , Physicians , Prescription Drugs , Proposed Rules

Proposed Rule on MA and Part D Would Reinstate Historical Requirements, Make Changes to Prescription Drug Payment Structure

On January 6, 2022, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit...more

1/11/2022 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Drug Pricing , Health Insurance , Medicare , Medicare Advantage , Medicare Part D , Pharmaceutical Industry , Prescription Drugs , Proposed Rules

[Webinar] Managed Care Spotlight: Recapping 2020 and Looking Ahead to 2021 - January 26th, 12:30 pm - 2:00 pm EST

Over the past year, we saw significant developments in managed care regulation at the federal and state levels, and we anticipate the rapid pace of change to continue in 2021. In this webinar, attendees will hear an analysis...more

1/12/2021 / Biden Administration , Drug Pricing , Health Care Providers , Health Insurance , Health Plan Sponsors , Managed Care Contracts , Medicare Advantage , Pharmaceutical Industry , Pharmacy Benefit Manager (PBM) , Physicians , Prescription Drugs , Price Transparency , Surprise Medical Bills , Webinars

CMS Guidance and Waivers for MA and Part D Plans’ Response to COVID-19

Over the past week, the Centers for Medicare & Medicaid Services (CMS) has made a number of announcements related to Medicare coverage in connection with the Coronavirus (COVID-19) outbreak. Several of those announcements...more

3/22/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Cost-Sharing , Medicare , Medicare Advantage , Medicare Part D , New Guidance , Public Health Emergency , State of Emergency , Waivers

CMS Issues Medicare Advantage and Part D 2021 Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) recently released three items relating to the Medicare Advantage and Part D programs: a proposed rule, Part II of the Advance Notice and Rate Announcement for Calendar Year...more

2/14/2020 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , ESRD , Health Care Providers , Hospitals , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part C , Medicare Part D , Pharmacies , Proposed Amendments , Star Ratings , Telehealth

CMS Seeks to Provide Flexibility and Facilitate Innovation in Medicare Advantage and Part D

The Centers for Medicare and Medicaid Services (CMS) recently released several significant Medicare Advantage (MA) and Part D guidance documents outlining new Center for Medicare and Medicaid Innovation (CMMI) programs and...more

2/8/2019 / Advance Notice , Bipartisan Budget Act , Call Letter , Centers for Medicare & Medicaid Services (CMS) , CMMI , GAO , Medicare Advantage , Medicare Part D , Opioid , Prescription Drugs , Risk Adjustment Formula , Social Security Act

Administration Offers Up New Proposals to Cut Drug Costs

On November 26, CMS released a notice of proposed rulemaking, “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses,” which includes provisions that aim to reduce overall drug...more

12/3/2018 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Life Sciences , Medicaid , Medicare Advantage , Medicare Part B , Medicare Part D , Pharmaceutical Industry

CMS Opens Module for MA Plans to Report MACRA Other Payer Advanced APM Information

The other payer advanced alternative payment model (APM) option is intended to give eligible clinicians an additional option to meet MACRA’s escalating participation thresholds to qualify for the 5 percent advanced APM bonus....more

6/1/2018 / Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Medicare Access and CHIP Reauthorization (MACRA) , Medicare Advantage , Payment Systems , Quality Payment Program (QPP)

CMS Encourages Innovation in MA, Asks Part D Plans to Combat Opioid Overuse, and Fine-Tunes Payments

The Centers for Medicare & Medicaid Services (CMS) has released its annual payment and policy guidance for Medicare Advantage and Part D plans. CMS is continuing to find ways to inject more flexibility into these programs,...more

2/7/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare Advantage , Medicare Part D

CMS Releases Broad-Ranging Medicare Advantage and Part D Proposed Rule

CMS released a broad-ranging proposed rule for the Medicare Advantage and Part D Programs on Thursday, November 16, 2017. The proposed rule addresses a broad and diverse range of MA and Part D regulatory requirements,...more

11/21/2017 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Part D , Pharmaceutical Industry , Pharmacies

Final Policies on Encounter Data and the Star Ratings Released

The Centers for Medicare and Medicaid Services recently finalized meaningful Medicare Advantage policy changes in response to industry concerns, including those regarding data integrity, the Star Ratings and encounter data....more

4/6/2017 / Centers for Medicare & Medicaid Services (CMS) , Data Collection , Medicaid , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Risk Adjustment Formula , Star Ratings

Medicare Advantage Draft Call Letter Addresses Encounter Data, Star Ratings

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released proposed updates to the Medicare Advantage (MA) and Part D programs through the CY 2018 Advance Notice and Draft Call Letter. Despite largely...more

2/8/2017 / Centers for Medicare & Medicaid Services (CMS) , Enforcement , Medicaid , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D

21st Century Cures: A Closer Look

On December 7, 2016, the US Congress enacted the 21st Century Cures Act, substantial legislation intended to accelerate “discovery, development and delivery” of medical therapies by encouraging biomedical research investment,...more

21st Century Cures: Congress Enacts Medicare Advantage and Small Business Insurance Market Reforms

The 21st Century Cures Act encourages biomedical research investment and facilitates innovation review and approval processes, but also serves as a vehicle for a wide variety of other health-related measures, including...more

12/12/2016 / 21st Century Cures Initiative , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , ESRD , Handbooks , HRA , Medicare Advantage , Open Enrollment , Risk Assessment , Star Ratings

CMS Releases Plan for Expanded Monitoring of Medicare Advantage and Part D Appeals and Grievances

In Depth - The Centers for Medicare & Medicaid Services (CMS) recently announced that it will monitor—beginning in January 2017—Part C and D appeals timeliness on an industry-wide basis. Under this initiative, all...more

12/6/2016 / Centers for Medicare & Medicaid Services (CMS) , Health Plan Sponsors , Medicare Advantage , Medicare Part D

MA Changes Shift Funding and Add Uncertainty to Already Complex Payment Methodologies

In Depth - The Centers for Medicare & Medicaid Services has enacted significant changes to Medicare Advantage (MA) payment methodologies that will shift payment towards MA organizations (MAOs) enrolling significant...more

5/4/2016 / Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Advantage , Payment Methods , Provider Payments

Preview of Medicare Advantage and Part D Advance Notice and Call Letter: CMS Likely to Address Risk Adjustment, Provider Network,...

The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year (CY) 2017. The...more

2/10/2016 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Fee-for-Service , Health Care Providers , Medicare Advantage , Medicare Part D , MedPAC , Recovery Audit Contractors (RACs) , Star Ratings

CMS Proposes to Restrict Diagnoses from Home Visits for Medicare Advantage Risk Adjustment

The Centers for Medicare and Medicaid Services has proposed to limit how Medicare Advantage Organizations can use in-home wellness or risk assessment visits of their enrollees to affect the risk adjusted payments they...more

2/25/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Healthcare Reform , Home Health Care , Medicare Advantage

CMS Releases 2014 Advance Notice and Proposed MA and Part D Program MLR Regulations

On February 15, 2013, the Centers for Medicare & Medicaid Services released for comment two key documents affecting the Medicare Advantage (MA) and Part D Programs: (1) the Advance Notice of Methodological Changes for...more

2/25/2013 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Medicaid , Medical Loss Ratio , Medicare , Medicare Advantage , Medicare Part D , MLR Rebate

Ankur Goel

McDermott Will & Emery

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