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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

VBC Symposium 2023 | Innovations in Value-Based Care for Complex Populations

During this session, Partner Jeremy Earl moderated a panel that discussed how value-based care models are delivering care to individuals with complex conditions and those with significant healthcare and social needs. The...more

CMS Announces Request for Applications for Participation In the ACO REACH Model

On February 24, 2022, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a Request for Applications (RFA) for the Accountable Care Organization (ACO) Realizing Equity, Access, and Community...more

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

[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

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

Special Report - 2019 Hospital and Health Systems Year in Review

Hospitals and health systems are facing consumer demand for innovation, the need to expand and enhance streams of revenue and the push for improved quality, all while navigating changing regulations, federal enforcement,...more

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

Flurry of Medicare Advantage and Part D Changes Includes Significant Policy Shifts

Last week, CMS released new regulations and guidance for Medicare Advantage Organizations (MAOs) and Part D Sponsors. These documents—along with the Bipartisan Budget Act of 2018 that was passed in January—reflect significant...more

Trump Administration Takes First Steps to Support Exchanges, but Key Questions Remain

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

CMS Indicates Select Controversial Part D Proposals Will Not Be Finalized

Acknowledging concerns regarding some proposals in the January 2014 proposed rule for the Medicare Advantage and Part D Programs, the Centers for Medicare & Medicaid Services states it does “not plan to finalize” certain...more

CMS Proposes Significant Changes to Medicare Part D Program’s Administration

The Centers for Medicare & Medicaid Services proposes significant changes to several key Medicare Part D Program components, such as the “any willing pharmacy” contracting requirement, that will affect all industry...more

CMS Proposed Rule Reflects Increased Sophistication in Administration of MA/Part D Programs

Addressing issues ranging from participation in Part D Plan pharmacy networks to compliance training for so-called first-tier, downstream and related entities, the Proposed Rule covers numerous topics with varying degrees of...more

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

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

CMS Announces Participants in Bundled Payment Initiative

The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced the health care organizations chosen to participate in the Bundled Payments for Care Improvement (BCPI) Initiative. The BCPI Initiative represents a...more

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