Jeremy Earl

Jeremy Earl

McDermott Will & Emery

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CMS Releases Guidance on Coverage Criteria, Use of AI and More

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

2/20/2024  /  Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare , Healthcare Reform , Medicare Advantage , New Guidance , Regulatory Requirements

CMS Interoperability and Prior Authorization Rule Significantly Impacts Payers’ Approval and Denial Practices

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website), which aims to improve prior...more

1/26/2024  /  Application Programming Interface (APIs) , Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Denial of Insurance Coverage , Federally Facilitated Exchanges , Final Rules , Health Care Providers , Health Insurance Portability and Accountability Act (HIPAA) , Medicaid , Medicare Advantage , MIPS , Patients , Qualified Health Plans , Single-Payer

CMS Proposes to Prohibit Overrides in Medicare Advantage

On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding Contract Year (CY) 2025 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug...more

11/10/2023  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Managed Care Contracts , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D , Proposed Rules

McDermott Health 2023 Annual Report: Managed Care 2022 Year in Review

The managed care space saw a number of regulatory and legislative developments in 2022 that are shaping the sector as we move further into 2023. Against this backdrop, the healthcare sector itself has continued to transform...more

3/16/2023  /  Acquisitions , CMMI , Employee Retirement Income Security Act (ERISA) , Healthcare Reform , Joint Venture , Legislative Agendas , Managed Care Contracts , Medicare Advantage , Mergers , New Legislation , New Regulations , Regulatory Agenda

[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 Unveils Geographic Direct Contracting Model

The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a Letter of Interest (LOI) for a new geographic model option within the Direct Contracting portfolio. The geographic model would transfer full...more

12/7/2020  /  ACOs , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Health Insurance Portability and Accountability Act (HIPAA) , HMOs , Medicare , Medicare Advantage

[Webinar] CMS Direct Contracting Model: Evaluating Participation and Managing Risk - December 1st, 1:30 pm - 2:30 pm EST

The Centers for Medicare and Medicaid Services (CMS) Direct Contracting Model presents an exciting move towards value-based care with benefits for participants, providers and patients alike. However, the model raises a number...more

11/18/2020  /  ACOs , Capital Requirements , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Medicare , Medicare Advantage , Medicare Shared Savings Program , Physicians , Risk Assessment , Risk Management , Value-Based Care , 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 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 to Allow Medicare Advantage Organizations to Utilize Step Therapy for Part B Drugs

The Centers for Medicare & Medicaid Services recently announced that, in a reversal of prior policy, it will begin to allow Medicare Advantage organizations (MAOs) to implement step therapy for Part B drugs and services as of...more

8/16/2018  /  Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part B

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)

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

1/21/2017  /  21st Century Cures Act , Ambulatory Surgery Centers , Digital Health , Food and Drug Administration (FDA) , Health Care Providers , Health Information Technologies , Health Insurance Portability and Accountability Act (HIPAA) , Hospitals , Long Term Care Facilities , Manufacturers , Medical Devices , Medicare , Medicare Advantage , MedPAC , Mental Health , Mental Health Parity Rule , National Institute of Health (NIH) , Off-Campus Departments , Opioid , Patients , Pharmaceutical Industry , Research and Development , Small Business , Substance Abuse , Telehealth , Transparency

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 Announces CY 2014 MA and Part D Rates with Change to Growth Rate Estimates

The Centers for Medicare & Medicaid Services (CMS) released the announcement of CY 2014 payment rates on April 1, which included its change in position regarding the assumption of the "doc fix" in estimates of Medicare...more

4/5/2013  /  Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Fees , Medicare , Medicare Advantage , Pharmacies , Risk Assessment

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
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