Susan Berson

Susan Berson

Mintz Levin

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The Managed Care Industry – 2015 Year in Review

As we start a new year, let’s take a look back at a few hot topics that emerged in the managed care industry in 2015 and will likely be drivers of developments in 2016. Industry Consolidation – The Changing Landscape...more

1/6/2016 - ACOs Affordable Care Act Healthcare Hospital Mergers Managed Care Contracts MCOs Medicare Part D Provider Payments Shared Savings Program

The Pharmacy Industry – 2015 Year In Review

With 2015 coming to a close, we wanted to provide a recap of the major updates impacting the pharmacy industry and what pharmaceutical manufacturers, pharmacy benefit managers (“PBMs”), and pharmacies might expect in 2016. ...more

12/9/2015 - AstraZeneca Biosimilars CMS DOJ Drug Pricing FDA Approval HRSA Kickbacks Kmart Novartis Pharmaceutical Industry Pharmacies Section 340B Value-Based Purchasing

Over a Decade in the Making: CMS Releases Long-Awaited Medicaid Managed Care Rule

On May 27, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published a 653-page proposed rule affecting the thirty-nine states (plus the District of Columbia) that use managed care organizations (“MCOs”) to...more

6/8/2015 - CMS Health Care Providers Managed Care Contracts Medicaid

CMS Call Letter: Provisions Related to Dual Eligible and Low Income Subsidy Individuals

For the last of our series on the 2016 Draft Call Letter, we focus on the provisions impacting plans serving Medicare-Medicaid, or dual eligible, enrollees. As we have previously posted, the Centers for Medicare & Medicaid...more

3/6/2015

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

CMS Proposes Major Changes to Medicare Part C and Part D

On Jan. 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

3/10/2014 - CMS Healthcare Medicare Medicare Part C Medicare Part D Pharmaceutical Industry Prescription Drugs

CMS Proposes Major Rule Changes to Increase Payment Accuracy and Improve Program Integrity in Medicare Part C and Part D

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

3/10/2014 - CMS Healthcare Medicare Medicare Part C Medicare Part D Pharmaceutical Industry Prescription Drugs

Notice to Plans and PBMs: Pay for Contraceptive Services and Maybe We Will Pay You Back

As has been widely covered in the news, regulations and guidance developed under the Affordable Care Act (“ACA”) require that non-grandfathered health plans make preventive care and screenings available to their members at no...more

2/18/2014 - Affordable Care Act Benefit Plan Sponsors Contraceptive Coverage Mandate Contraceptives Employee Benefits FDA Healthcare HHS

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

Final Mental Health Parity Rules Released

The Departments of Health and Human Services, Labor, and the Treasury jointly issued a long-awaited final rule that implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008...more

11/12/2013 - Affordable Care Act Drug & Alcohol Abuse Essential Health Benefits Healthcare Healthcare Reform HHS Mental Health Parity Rule Mental Illness MHPAEA

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

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

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