Roy M. Albert

Roy M. Albert

Mintz Levin

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The Affordable Care Act—Countdown to Compliance for Employers, Week 22: Charting the Future of the Premium Subsidies (and Employer...

On July 22, 2014, two federal appellate courts issued conflicting decisions, within hours of each other, regarding the IRS final rule published on May 23, 2012 (the “IRS Rule”), intended to implement the exchange-related tax...more

7/28/2014 - Affordable Care Act Chevron Deference Employer Mandates Halbig v Burwell Health Insurance Health Insurance Exchanges Healthcare Reform IRS King v Burwell Subsidies Tax Credits

Charting the Future of Premium Subsidies under the Affordable Care Act: Halbig v. Burwell and King v. Burwell

On July 22, 2014, two federal appellate courts issued conflicting decisions, within hours of each other, regarding the IRS final rule published on May 23, 2012 (the “IRS Rule”), intended to implement the exchange-related tax...more

7/25/2014 - Affordable Care Act Halbig v Burwell Healthcare IRS King v Burwell Subsidies Tax Credits

The Future of Premium Subsidies under the Affordable Care Act: 'Halbig v. Burwell' and 'King v. Burwell'

Both decisions addressed whether tax credits are available for residents in states that have federally-facilitated health exchanges. The District of Columbia Court of Appeals said “no”; the Fourth Circuit Court of Appeals...more

7/23/2014 - Affordable Care Act Chevron v NRDC First Glance Halbig v Burwell Health Insurance Exchanges King v Burwell Legal Perspectives Popular

HHS Report Highlights “Surge” In Enrollment in Health Insurance Marketplaces

Last week, HHS’s Office of the Assistant Secretary for Planning and Evaluation published a Report offering health plan enrollment data for the state-based insurance marketplaces authorized by the Affordable Care Act...more

5/8/2014 - Affordable Care Act Health Insurance Exchanges Healthcare HHS Open Enrollment Public Health Insurance Marketplace

CMS Issues Final Call Letter for 2015

Earlier this week, CMS announced in its Final Call Letter that Medicare Advantage rates would rise an average of 0.4 percent in 2015, instead of falling 1.9 percent as proposed in February. CMS’s shift in course may stem...more

4/10/2014 - CMS Healthcare Medicare Medicare Advantage

OIG Issues Favorable Opinion of Arrangement Containing Percentage-Based Compensation Structure

Last week, the OIG issued an advisory opinion indicating that it would not impose sanctions on an arrangement pursuant to which a placement agency receives a percentage-based fee for referring new residents to senior...more

2/4/2014 - Elder Care Elder Issues Nursing Homes OIG

CMS Proposes Major Changes to Medicare Parts C and D

On January 10, the Centers for Medicare & Medicaid Services (CMS) published proposed rules labeled as “policy and technical” changes to the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) Programs....more

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

CMS Issues Medicare Physician Fee Schedule Without Finalizing Proposal Most Harmful to Independent Laboratories

On the day before Thanksgiving and a little over one month after the end of the government shutdown, the Centers for Medicare & Medicaid Services (“CMS”) published a rule finalizing revisions to payment policies under the...more

12/4/2013 - Clinical Laboratories CMS Healthcare Medicare MPFS Physician Fee Schedule Physicians

Government Shutdown Aftermath: CMS Under Pressure to Finalize Medicare Payment Rules

..Because of the prolonged government shutdown, the Centers for Medicare & Medicaid Services (CMS) may encounter delays in promulgating final payment rules that would otherwise be effective January 1, 2014. ..It is...more

10/21/2013 - CMS Home Health Care Medicare Payment Plans

CMS Issues Star Ratings for the 2014 Plan Year

On October 11, 2013, CMS posted the 2014 Medicare Health Plan Quality and Performance Ratings, which are commonly referred to as “Star Ratings.” CMS released the 2014 Star Ratings several days later than originally...more

10/15/2013 - CMS Health Plan Sponsors Medicare Ratings Sponsors

Bipartisan Agreement Reached on Legislation Granting FDA Greater Authority to Regulate Drug Compounders

Last week, Democrat and Republican leaders of both houses of Congress agreed to the terms of a bill that would give the U.S. Food and Drug Administration (FDA) greater authority to regulate drug compounding and would revamp...more

10/1/2013 - Drug Compounding FDA Fungal Meningitis GAO Pharmacies

OIG and MA Plan Sponsor Settle Allegations of Altering Records Submitted During Audit

Bravo Health Pennsylvania, Inc. (Bravo), a Medicare Advantage Plan Sponsor and subsidiary of Cigna Corporation, agreed to pay $225,000 to the Government for allegedly misrepresenting or falsifying information furnished to the...more

8/16/2013 - Audits CIGNA CMS False Statements Falsified Documents Medical Records Medicare Misrepresentation OIG

Proposed Medicare Cuts Would Significantly Impact Independent Laboratories

Last week, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule setting forth revisions to payment policies under the Medicare Physician Fee Schedule (MPFS) and other revisions to Medicare Part B for...more

7/22/2013 - Clinical Laboratories CMS Medical Research Medicare Payment Plans

CMS Conducts Star Ratings Best Practices Webinar

CMS hosted a webinar yesterday focusing on best practices for Medicare Advantage and Prescription Drug Plan Sponsors looking to enhance their Star Ratings. As described in our article and previous blog posts, Star Ratings...more

6/27/2013 - CMS Healthcare Insurers Medicare Advantage Prescription Drug Plans Prescription Drugs

CMS Issues Final MLR Rule for Medicare Advantage and Part D Programs

Last week, CMS published a final rule implementing the ACA’s medical loss ratio (“MLR”) requirements that will apply to the Medicare Advantage (Part C) and prescription drug (Part D) programs beginning in contract year 2014. ...more

5/22/2013 - Affordable Care Act CMS Healthcare Medical Loss Ratio Medicare Medicare Advantage Medicare Part C Medicare Part D

Despite the ACA’s Cost-Saving Measures, Modest Increases in Health Care Costs Unlikely to Continue

Earlier this week, the Kaiser Family Foundation and the Altarum Institute’s Center for Sustainable Health Spending published an analysis of the recent slowdown in health care spending. The study asserts that macroeconomic...more

4/25/2013 - Affordable Care Act Cost-Containment Healthcare

2014 Final Call Letter: CMS Raises Medicare Advantage Rates but Foreshadows Other Significant Program Changes

After receiving many comments on its Draft Call Letter, CMS published its Contract Year 2014 Final Call Letter on April 1, 2013. The Final Call Letter addresses a wide variety of issues that will affect all parties involved...more

4/17/2013 - Beneficiaries CMS Controlled Substances Medical Reimbursement Plans Medicare Advantage Modification Pharmacies Point of Sale Terminals Prescription Drugs Waivers

OIG Approves Gift Cards to Encourage Clinical Visits to Health Center

In Advisory Opinion 12-21, the OIG concluded that a Federally qualified health center’s offer of grocery store gift cards to capitated managed care patients would not constitute grounds for the imposition of sanctions under...more

1/10/2013 - Anti-Kickback Statute Gift-Cards Medicaid Medicare OIG

Medicare Star Ratings – What Plan Sponsors Need to Know By Theresa C. Carnegie and Roy M. Albert

Originally published in BNA’s Medicare Report, 11/30/2012. On Oct. 12, the Centers for Medicare & Medicaid Services published its 2013 Medicare Health Plan Quality and Performance Ratings, also called ‘‘Star Ratings’’...more

12/3/2012 - Affordable Care Act CMS Medicare

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