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
The emergence of joint ventures between health systems and payors is quickly reshaping the healthcare sector as we know it—presenting both new complexities and fresh opportunities for the changemakers involved....more
10/13/2023
/ Analytics ,
Antitrust Provisions ,
Collaboration ,
Continuing Legal Education ,
Contract Drafting ,
Contract Termination ,
Data Privacy ,
Data Security ,
Dispute Resolution ,
Fraud and Abuse ,
Health Care Providers ,
Health Insurance ,
Healthcare Facilities ,
Intellectual Property Protection ,
Joint Venture ,
Partnerships ,
Payor Contracts ,
Regulatory Requirements ,
Risk-Sharing ,
Webinars
As the lines between payors and providers continue to blur, the market is awash with payor-provider joint ventures, and McDermott is at the forefront of structuring and negotiating these strategic transactions.
Health...more
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
In an effort to stabilize the Exchanges and encourage issuer participation, the Centers for Medicare & Medicaid Services (CMS) recently extended the federal Exchange application and rate filing deadlines and published a...more
2/27/2017
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
De Minimis Claims ,
Department of Health and Human Services (HHS) ,
Enrollment ,
Executive Orders ,
Filing Deadlines ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Open Enrollment ,
Proposed Rules ,
Qualified Health Plans ,
Trump Administration
On June 25, 2015, the Supreme Court of the United States ruled in King v. Burwell that the Affordable Care Act (ACA) requires premium tax credits to be made available in states that use a federal exchange. The case challenged...more
The Supreme Court of the United States is poised to decide a critical question under the Affordable Care Act: whether the federal government can subsidize health insurance premiums for residents of states that did not...more