WHERE VALUE-BASED CARE MEETS THE BUSINESS OF HEALTHCARE -
Join hundreds of c-suite leaders, investors, operators and counsel in the healthcare capital of the United States for a deep dive into the key business and policy...more
5/6/2024
/ Best Practices ,
Business Development ,
Business Model ,
Business Opportunities ,
Continuing Legal Education ,
Data Privacy ,
Events ,
Exceptions ,
Health Care Providers ,
Health Plan Sponsors ,
Healthcare Costs ,
Innovation ,
Investment Opportunities ,
Investors ,
Joint Venture ,
Partnerships ,
PHI ,
Risk Adjustment Formula ,
Risk Management ,
Safe Harbors ,
Specialty Healthcare ,
Value-Based Care
On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule and press release revising the regulations governing the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program,...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
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
On July 7, 2023, the US Departments of Health and Human Services, Labor, and Treasury (collectively, the departments) released a Notice of Proposed Rulemaking (NPRM) and Fact Sheet that proposes to revise the definition of...more
For plans governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (ERISA), the doctrine of federal ERISA preemption over state statutes, regulations or administrative schemes has been a central...more
4/13/2023
/ Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Health and Welfare Plans ,
Managed Care Contracts ,
Pharmaceutical Industry ,
Pharmacies ,
Pharmacy Benefit Manager (PBM) ,
Preemption ,
Prescription Drugs ,
Reimbursements
During this session, Samarth Chandra, Kunal Kain, John Smith and Partners Jeremy Earl and Kate McDonald moderated a panel that examined the current market for value-based care companies and how investors can identify...more
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
On January 6, 2022, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit...more
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
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
The COVID-19 pandemic has catalyzed efforts by health insurers to expand reimbursement for telehealth services and digital health tools, and develop and invest in their own digital health technology. Health insurers, who...more
The COVID-19 pandemic has catalyzed efforts by health insurers to expand reimbursement for telehealth services and digital health tools, and develop and invest in their own digital health tools. Health insurers, who...more
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
2/6/2020
/ Antitrust Litigation ,
Centers for Medicare & Medicaid Services (CMS) ,
CMIA ,
Cyber Attacks ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Hospitals ,
Medicare ,
No-Poaching ,
OCR ,
Popular ,
Ransomware
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
On January 31, 2019, the Department of Health and Human Services (HHS) released a notice of proposed rulemaking (the Proposed Rule) as part of ongoing administration drug pricing reform efforts. The Proposed Rule would modify...more
2/4/2019
/ Anti-Kickback Statute ,
Comment Period ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Health Plan Sponsors ,
Manufacturer Liability ,
MCOs ,
Medicare ,
Medicare Part D ,
Notice of Proposed Rulemaking (NOPR) ,
Pharmaceutical Industry ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
Proposed Rules ,
Public Comment ,
Regulatory Agenda ,
Safe Harbors
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
On October 26, 2018, CMS released a Notice of Proposed Rulemaking addressing expanded telehealth coverage in Medicare Advantage, extrapolation of RADV audit results, and updates to the Medicare Advantage and Part D Quality...more
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
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
The Centers for Medicare & Medicaid Services (CMS) has released its annual payment and policy guidance for Medicare Advantage and Part D plans. CMS is continuing to find ways to inject more flexibility into these programs,...more
CMS released a broad-ranging proposed rule for the Medicare Advantage and Part D Programs on Thursday, November 16, 2017. The proposed rule addresses a broad and diverse range of MA and Part D regulatory requirements,...more
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
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