Philo Hall

Philo Hall

Epstein Becker & Green

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MACRA Proposed Rule: CMS Provides Details on Implementing Medicare’s New Quality Payment Program

On May 9, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule addressing the implementation of physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015...more

5/31/2016 - Alternative Payment Models (APM) CMS Medicare Access and CHIP Reauthorization (MACRA) MIPS PQRS

Doing the Cha-Cha on Exchange Rules: CMS Moves Forward on Standardized Plan Offerings but Steps Back from Instituting Minimum...

On March 8, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule titled “Patient Protection and Affordable Care Act; CMS Notice of Benefit and Payment Parameters for 2017” (“Final Rule”)[1] setting...more

3/17/2016 - Affordable Care Act CMS Final Rules Health Insurance Exchanges Qualified Health Plans

CMS Proposes Modest Increases to Medicare Advantage and Part D Plan Payment Rates Accompanied by Significant Revisions to Risk...

The Advance Notice (“Advance Notice”) of Methodological Changes for Calendar Year (“CY”) 2017 for Medicare Advantage (“MA”) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter was released by the Centers...more

2/26/2016 - Affordable Care Act CMS Medicare Advantage Medicare Part D

“Next-Generation ACO” Model Is CMS’s Newest Effort to Encourage More ACO Risk

On March 10, 2015, the Centers for Medicare & Medicaid Services’ (“CMS’s”) Center for Medicare and Medicaid Innovation (“Innovation Center”) announced a demonstration project incorporating new risk models for reimbursement of...more

3/17/2015 - ACOs CMS Medicaid Medicare Physician Medicare Reimbursements

CMS Takes a Measured Approach to Medicare Advantage and Part D Plan Payment Rates and Policy Changes for 2016

Increased Part D Drug Costs Set the Stage for Higher Beneficiary Premiums - The Advance Notice (“Advance Notice”) of Methodological Changes for Calendar Year (“CY”) 2016 for Medicare Advantage (“MA”) Capitation Rates,...more

2/24/2015 - CMS Medicare Medicare Advantage Medicare Part D Pharmaceutical Industry Physician Payments Prescription Drugs Value-Based Purchasing

HHS Broadens Federal Controls Over Private Health Insurance Benefits and Operations

On November 21, 2014, the Obama administration released two proposed rules affecting health insurance issuers’ offering of private health insurance products both inside and outside of the public insurance exchanges...more

12/8/2014 - Affordable Care Act Barack Obama Essential Health Benefits Health Insurance Health Insurance Exchanges Healthcare Reform HHS Minimum Essential Coverage Multiemployer Plan Proposed Regulation

Medicare Shared Savings Program Proposed Rule: Enough Incentive to Encourage More ACO Risk?

On December 1, 2014, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) setting forth long-anticipated changes to the Medicare Shared Savings Program (“MSSP”), including payments...more

12/5/2014 - ACOs CMS Healthcare Medicare Shared Savings Program Proposed Regulation

CMS's Final Exchange and Insurance Market Standards Impact Qualified Health Plan Filings for 2015 and Beyond

On May 16, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule titled "Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond" ("Final Rule")...more

6/9/2014 - Affordable Care Act CCIIO CMS Employer Mandates Federally Facilitated Exchanges Final Rules Health Insurance Exchanges Healthcare Popular Qualified Health Plans Small Business

OIG Supplemental Advisory Bulletin on Patient Assistance Programs Leaves Open Questions for High-Cost Breakthrough Drugs in...

On May 21, 2014, the Office of the Inspector General ("OIG") of the Department of Health and Human Services issued a Supplemental Special Advisory Bulletin ("Supplemental Bulletin") addressing the risks that Independent...more

5/30/2014 - Healthcare HHS Medicare Medicare Part D OIG Patient Assistance Programs Pharmaceutical Industry Prescription Drugs

CMS Scaled Back Changes to the Medicare Part D Prescription Drug and Medicare Advantage Programs, but Some Important Revisions...

On May 19, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule ("Final Rule") completing changes to the Medicare Program's outpatient prescription drug benefit ("Part D") program and the Medicare...more

5/22/2014 - CMS Disclosure Requirements Final Rules Medicaid Medicare Medicare Advantage Medicare Part D Prescription Drug Coverage Prescription Drugs

2015 Payment Notice and Final Call Letter: A Mixed Bag for Medicare Advantage and Prescription Drug Plans

On April 7, 2014, the Centers for Medicare & Medicaid Services ("CMS") released the Announcement of Calendar Year ("CY") 2015 Medicare Advantage ("MA") Capitation Rates and Medicare Advantage and Part D Payment Policies...more

4/14/2014 - CMS Healthcare Medicaid Medicare Advantage Medicare Part D

CMS Proposes Significant Rate Cuts and Other Changes to Medicare Advantage and Prescription Drug Plans

The Advance Notice ("Advance Notice") of Methodological Changes for Calendar Year ("CY") 2015 for Medicare Advantage ("MA") Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter was released by the Centers...more

2/24/2014 - Advance Notice Affordable Care Act CMS Fee-for-Service Healthcare Medicare Advantage Medicare Part D Pharmaceutical Industry Pharmacies Physician Medicare Reimbursements Prescription Drug Coverage Provider Payments Risk Assessment

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