Kate McDonald

Kate McDonald

McDermott Will & Emery

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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 - CMS Enforcement Medicaid Medicare Medicare Advantage Medicare Advantage Organizations (MAOs) Medicare Part D

Managing the Transition to Transformation: Expanding the Health Care Paradigm

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

2/2/2017 - ACOs Alternative Payment Models (APM) Healthcare Medical Reimbursement

Managing the Transition to Transformation: State Insurance Law and Provider Risk under Alternative Payment Models

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

1/5/2017 - Alternative Payment Models (APM) Health Care Providers Healthcare

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 CMS ESRD Handbooks HRA Medicare Advantage Open Enrollment Risk Assessment Star Ratings

How Congress, President-Elect Trump Might Proceed on Promise to Repeal, Replace ACA

President-elect Donald Trump has vowed to repeal and replace the Affordable Care Act (ACA). This campaign promise, which echoes a familiar refrain from Republicans since ACA’s passage, is more complex than it may seem....more

11/11/2016 - Affordable Care Act Political Candidates Presidential Elections Trump Administration

New Medicare Enrollment Requirements for MA Providers

In Depth - The Medicare Physician Fee Schedule proposed rule released by the Centers for Medicare & Medicaid Services (CMS) on July 7, 2016, (the Proposed Rule) requires certain providers and suppliers furnishing health...more

7/26/2016 - CMS Enrollment General Services Administration (GSA) Medicaid Medicare Medicare Advantage Medicare Advantage Organizations (MAOs) Medicare Part D OIG Physician Fee Schedule Prescription Drug Coverage

CMS’s Final Medicaid Rule Creates a Medicaid MLR Framework but Leaves Room for State Variation

In Depth - The final Medicaid managed care rule issued by the Centers for Medicare & Medicaid Services (CMS) on April 25, 2016, (the Final Rule) establishes a new federal medical loss ratio (MLR) standard for Medicaid...more

5/12/2016 - CHIP CMS Managed Care Contracts Medicaid Medical Loss Ratio

CMS Proposes Increased Transparency of Hospice Quality Data in Annual Payment Update

In Depth - On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding updates to fiscal year (FY) 2017 Medicare payment rates and the wage index for hospices serving Medicare...more

5/5/2016 - Beneficiaries CMS Hospice Medicare Transparency

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 - CMS Medicaid Medicare Medicare Advantage Payment Methods Provider Payments

Strategizing to Operationalize the Medicare Advantage and Part D Final Rule

More than a year ago, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed significant regulatory changes to the Medicare Advantage (MA) and Part D Programs, many of which were the subject of significant...more

2/24/2016 - CMS Final Rules Medicare Advantage Medicare Part D Prescription Drug Coverage

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 - CMS Comment Period Fee-for-Service Health Care Providers Medicare Advantage Medicare Part D MedPAC Recovery Audit Contractors (RACs) Star Ratings

Shifting Hospice Reimbursement – Moving in the Direction of Aligning Payment with Resource Concentration

The United States Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) published its update to the home health prospective payment system (HHPPS) for fiscal year (FY) 2016 in the August...more

8/20/2015 - Bundled Payments CMS HHS Home Health Care Hospice Medicaid Medicaid Reimbursements Patient Prospective Payment System

Medicaid Managed Care Update: Program Integrity Proposals Include Mandatory Reporting of Overpayments by Medicaid Managed Care...

CMS seeks to impose more rigorous program integrity requirements for contractors and states. This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations,...more

6/18/2015 - CMS False Claims Act (FCA) Health Care Providers Managed Care Contracts Medicaid Overpayment

Strategizing to Operationalize the Medicare Advantage and Part D Final Rule

More than a year ago, the U.S. Centers for Medicare & Medicaid Services (CMS) proposed significant regulatory changes to the Medicare Advantage (MA) and Part D Programs, many of which were the subject of significant...more

2/18/2015 - CMS Final Rules Medicare Medicare Advantage Medicare Part D Regulatory Agenda

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

3/17/2014 - CMS Healthcare Medicare Medicare Part D

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

1/24/2014 - CMS Healthcare Healthcare Reform Medicaid Medicare Medicare Part D Pharmacies

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

1/22/2014 - CMS Healthcare Medicare Medicare Part D

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