Helaine Fingold

Helaine Fingold

Epstein Becker Green

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CMS Releases Updates to Its Medicare Advantage and Part D Plan Audit Protocols and Processes

On February 12, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released an updated version of its Medicare Advantage (“MA”) and prescription drug benefit (“Part D”) plan audit protocols and also announced the...more

3/2/2015 - Audits CMS Medicare Medicare Advantage Medicare Part D

Obama Administration Seeks Comments on Proposed Changes to Summary of Benefits and Coverage Document and Requirements

On December 30, 2014, the Departments of Health and Human Services, Labor, and the Treasury (collectively, “Departments”) issued a proposed rule (“Proposed Rule”) regarding the summary of benefits and coverage (“SBC”) for use...more

1/13/2015 - DOL Employer Group Health Plans Health Insurance HHS Proposed Regulation Safe Harbors Summary of Benefits and Coverage U.S. Treasury

Proposed Exemption of Limited Wraparound Coverage from Health Insurance Market Standards

On December 19, 2014, various federal agencies issued proposed regulations (“Proposed Regulations”) to amend the definition of “excepted benefits” to include certain limited wraparound health insurance coverage. “Excepted...more

1/7/2015 - Affordable Care Act ERISA Health Insurance IRC PHSA Popular Proposed Amendments Proposed Regulation Wraparound Coverage

CMS Releases Key Proposals for the 2016 Qualified Health Plan Application Process

Stakeholders received insight on the Obama administration’s expected approach to the certification and oversight of qualified health plans (“QHPs”) on December 19, 2014, with the release by the Centers for Medicare & Medicaid...more

1/6/2015 - Certifications CMS Health Care Providers Healthcare Medicaid Medicare Public Health Insurance Marketplace Qualified Health Plans

CMS Seeks Comments on Proposed Enhancements and Modifications to the Star Ratings for Medicare Advantage and Part D Prescription...

On November 21, 2014, the Centers for Medicare & Medicaid Services (“CMS”) released a Request for Comments on proposed enhancements and modifications to the 2016 Star Ratings for Medicare Advantage (“MA”) and Part D...more

12/11/2014 - CMS Comment Period Medicare Advantage Medicare Part D

HHS Broadens Federal Controls Over Private Health Insurance Benefits and Operations

On November 21, 2014, the Obama administration released two proposed rules affecting health insurance issuers’ offering of private health insurance products both inside and outside of the public insurance exchanges...more

12/8/2014 - Affordable Care Act Barack Obama Essential Health Benefits Health Insurance Health Insurance Exchanges Healthcare Reform HHS Minimum Essential Coverage Multiemployer Plan Proposed Regulation

CMS Cost Sharing Reduction Reconciliation Reporting for QHPs

Qualified Health Plans (“QHPs”) and other stakeholders have until October 27, 2014, to comment on CMS’s proposed cost sharing reduction payment reconciliation reporting process. On Friday, September 26, 2014, CMS released...more

10/13/2014 - Affordable Care Act CMS Employee Benefits Healthcare Healthcare Reform Qualified Health Plans

CMS Requests Input on Health Plan Innovation Initiatives

Medicare Advantage (“MA”) plans, prescription drug plans (“PDPs”), and other stakeholders have until November 3, 2014, to provide input into the Centers for Medicare & Medicaid Services’ (“CMS’s”) consideration of potential...more

10/10/2014 - CMS Innovation Medicaid Medicare Advantage Prescription Drug Plans Request For Information Supplemental Benefits Technology

HEAL Advisory: How Big Is Halbig? The Potential Effects of This Major Ruling Are Numerous and Significant

On July 22, 2014, the U.S. Court of Appeals for the D.C. Circuit and the U.S. Court of Appeals for the Fourth Circuit issued conflicting opinions on a key aspect of the Affordable Care Act ("ACA"). The cases are Halbig v....more

7/30/2014 - Affordable Care Act Appeals Barack Obama Employer Mandates En Banc Review Halbig v Burwell Health Insurance Health Insurance Exchanges Healthcare Reform King v Burwell SCOTUS Subsidiaries Tax Credits

CMS's Final Exchange and Insurance Market Standards Impact Qualified Health Plan Filings for 2015 and Beyond

On May 16, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule titled "Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond" ("Final Rule")...more

6/9/2014 - Affordable Care Act CCIIO CMS Employer Mandates Federally Facilitated Exchanges Final Rules Health Insurance Exchanges Healthcare Popular Qualified Health Plans SHOPS Small Business

CMS Scaled Back Changes to the Medicare Part D Prescription Drug and Medicare Advantage Programs, but Some Important Revisions...

On May 19, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule ("Final Rule") completing changes to the Medicare Program's outpatient prescription drug benefit ("Part D") program and the Medicare...more

5/22/2014 - CMS Disclosure Requirements Final Rules Medicaid Medicare Medicare Advantage Medicare Part D Prescription Drug Coverage Prescription Drugs

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace

At a Centers for Medicare & Medicaid Services ("CMS") teleconference titled "Compliance Reviews in the Federally-Facilitated Marketplace" ("FFM"), which was held on April 10, 2014, CMS representatives discussed the agency's...more

4/14/2014 - Audits CMS Compliance Healthcare Medicaid Medicare Qualified Health Plans

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