News & Analysis as of

Health Insurance Centers for Medicare & Medicaid Services

Medicare Advantage 2018 Rate Announcement

The Centers for Medicare and Medicaid Services (CMS) announced its 2018 Medicare Advantage (MA) capitation rates, with an expected increase of .45 percent, slightly higher than proposed in the advance notice. CMS estimates...more

Market Stabilization Rule: Assessing the Trump Administration's First ACA Market-Related Regulation

by Faegre Baker Daniels on

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized its Marketplace Stabilization Rule. This is the first Trump administration regulation that applies to the health insurance markets remade by...more

Wisconsin Releases Draft Waiver Amendment Proposing New Eligibility Requirements

On April 19, 2017, Wisconsin released for public comment a proposed amendment to its BadgerCare Reform Section 1115 demonstration. BadgerCare Reform currently provides coverage to approximately 150,000 childless adults ages...more

Market Stabilization: To Be or Not to Be?

by BakerHostetler on

The Centers for Medicare and Medicaid Services (CMS) published a Final Rule intended to stabilize the individual and small group insurance markets on April 18, 2017. Reflecting the urgent need to address the uncertainty...more

D.C. District Court Allows Part C Plan to Continue with Challenge of Overpayment Rule

by King & Spalding on

On March 31, 2017, Judge Rosemary Collyer of the United States District Court for the District of Columbia held that plaintiffs UnitedHealthcare Insurance Company et al. (“United”) had standing to challenge CMS’s overpayment...more

Issue 108: HHS Moves Ahead In Face of ACA Uncertainty

by Seyfarth Shaw LLP on

This is the one hundred and eighth issue in our series of alerts for employers on selected topics on health care reform. This series of Health Care Reform Management Alerts is designed to provide an in-depth analysis of...more

CMS Issues Final Rule to Stabilize ACA Insurance Markets, While Emphasizing Marketplace Woes

by Reed Smith on

The Centers for Medicare & Medicaid Services has published a final rule intended to help improve the risk pool and stabilize the Affordable Care Act (ACA) Insurance Exchanges for 2018 – even as CMS contends that consumers...more

Capitol Hill Healthcare Update

by BakerHostetler on

House Republicans of all ideological stripes say they are committed to rekindling interest in the American Health Care Act (AHCA), but while the interest is real, so too are the policy and political divisions that thwarted...more

Manatt on Medicaid: Monthly Expansion Recap, March 2017 #2

Arkansas - Governor Proposes Changes to Medicaid Expansion Waiver as House Passes Bill to Cap Expansion Enrollment - Governor Asa Hutchinson (R) released a proposal to amend the State's Medicaid expansion waiver by...more

CMS Delays Implementation of New Payment Models (Again)

On March 21, 2017, the Centers for Medicare and Medicaid Services (“CMS”) published an interim final rule (“Interim Final Rule”) delaying (i) the effective date of several new Medicare payment models developed by the CMS...more

ACA Repeal and Replace Update: House Vote Expected This Week; CBO Estimates Impact of Repeal and Replace Legislation; CMS...

by King & Spalding on

After narrowly passing the Budget Committee, the Republican-sponsored health reform repeal and replace bill, the American Health Care Act (AHCA), is scheduled for a floor vote for Thursday, March 23, 2017, seven years to the...more

A New Era for Medicaid

by Arnall Golden Gregory LLP on

Congress is currently debating the American Health Care Act (AHCA), the “repeal and replace” legislation that calls for fundamental changes to Medicaid. As currently proposed, AHCA will cut Medicaid spending by $880 billion...more

Healthcare Law Update: March 2017

by Holland & Knight LLP on

Enforcement - OIG Issues Advisory Opinion Allowing Free or Reduced-Cost Lodging and Meals - On March 3, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG) issued...more

Third-Party Payment of Premiums: Controversy and HHS Guidance

Since the passage of the Affordable Care Act (ACA), the payment of healthcare premiums by third parties has been the subject of controversy. As Congress develops its plan to repeal and replace the ACA, it is uncertain how...more

Health Update - March 2017

The Future of Essential Health Benefits - Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more

The Transition to Value-Based Health Care: A View from Washington of President Trump’s First 60 Days

by Ropes & Gray LLP on

“A View from Washington of President Trump’s First 60 Days,” the inaugural segment of our value-based health care teleconference series, was hosted by Thomas Bulleit, who heads the Ropes & Gray health care practice in the...more

Manatt on Health Reform: Weekly Highlights - March 2017 #2

CBO finds that the number of uninsured would nearly double under the American Health Care Act; CMS's new Administrator is confirmed; and New Mexico and Massachusetts move to protect reproductive healthcare under ACA repeal....more

Direct Primary Care: Getting Calls from Patients While Avoiding Calls from Law Enforcement

by Snell & Wilmer on

For providers interested in simplifying the provider-patient relationship, one option is direct primary care. Ironically, though, simplification can be complicated, particularly when the government is involved. One of the...more

House Republicans Release Obamacare Repeal and Replace Policy Brief; Senate Finance Committee Holds Hearing on Verma CMS...

by King & Spalding on

On February 16, 2017, House Republicans released a policy brief on how to repeal and replace the Affordable Care Act (ACA). The brief builds upon the ideas outlined in the 2016 “A Better Way” proposal and promises action on...more

New Medicare Conditional Payment Case: Federal Court Requires CMS To Perform Surgery On Its Primary Plan Reimbursement Demands

Doctors often treat Medicare beneficiaries for accident related injuries (for which a “primary” auto or workers’ compensation carrier must reimburse Medicare) and unrelated maladies at the same visit. Billing for the visit...more

Trump Administration Takes First Steps to Support Exchanges, but Key Questions Remain

by McDermott Will & Emery on

In an effort to stabilize the Exchanges and encourage issuer participation, the Centers for Medicare & Medicaid Services (CMS) recently extended the federal Exchange application and rate filing deadlines and published a...more

CMS Releases Proposed Rule for ACA Market Stabilization

by Epstein Becker & Green on

On February 15, 2017, the Centers for Medicare & Medicaid Services (“CMS”), at the direction of the Trump administration, released a long-expected proposed rule (“Market Stabilization Proposed Rule”)designed to help stabilize...more

CMS Proposes Affordable Care Act Exchange, Individual, and Small Group Insurance Market Changes

by Dorsey & Whitney LLP on

Not relying on Congress to take action on the Affordable Care Act, the Centers for Medicare and Medicaid Services (“CMS”) has proposed new regulations intended to attract health insurance issuers back into ACA health...more

Reducing the Regulatory Stranglehold on Federally Facilitated Exchanges: Will It Work?

by BakerHostetler on

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule aimed at improving the individual and small group markets that have been plagued with instability as issuers continue exiting the Exchanges....more

CMS Proposes Changes to Stabilize ACA Health Insurance Markets

by Reed Smith on

At the same time Republican Congressional leaders are attempting to develop legislation to repeal and replace the Affordable Care Act (ACA), CMS has published a proposed rule that is intended to help stabilize the Affordable...more

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