News & Analysis as of

Manatt on Medicaid: The Numbers

Even as the news media tries to untangle the latest data on Marketplace enrollment, an equally important and still-evolving story is playing out on the Medicaid side of the open enrollment equation. According to a Centers for...more

Health Headlines: Also in the News

340B “Mega-Reg” Under Review by OMB – The Health Resources and Service Administration (HRSA), Office of Pharmacy Affairs sent the long-awaited 340B Proposed Rule to the Office of Budget and Management Affairs (OMB) last week...more

CMS Proposes Adoption of Updated Life Safety Code

Wednesday morning, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding adopting the 2012 edition of the Life Safety Code (LSC). CMS states the updated code contains new provisions that are...more

CMS Issues Medicare Advantage And Part D Final Call Letter For 2015

The Medicare Advantage and Part D Final Call Letter announces requirements for the 2015 contract year, including changes to Part C and Part D star ratings and how CMS will evaluate Part D plan structures submitted for the...more

CMS Releases Rate Announcement and Final Call Letter for Medicare Advantage and Part D Programs

On April 7, 2014, CMS issued the 2015 rate announcement and final call letter for the Medicare Advantage and Part D programs. Notably, CMS reversed planned rate cuts to Medicare Advantage plans, and is instead replacing those...more

An Analysis Of Physician Compare Website

The rise of consumer-driven health care passed a milestone on Feb. 21, when, for the first time, the Centers for Medicare and Medicaid Services, or CMS, posted on its Physician Compare website performance scores on quality...more

Don't Be Left On The Sidelines: CMS Is Seeking Applications For A New Hospice Demonstration Program

Currently, Medicare patients that wish to receive palliative hospice care have a tough choice to make—forgo any curative treatment or incur all hospice care costs. This could change, however, with the recent launch of CMS's...more

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace

At a Centers for Medicare & Medicaid Services ("CMS") teleconference titled "Compliance Reviews in the Federally-Facilitated Marketplace" ("FFM"), which was held on April 10, 2014, CMS representatives discussed the agency's...more

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

Also in the News

CMS to Provide Public Access to Physician Payment Data – In a recent post on its official blog, CMS announced it will provide “unprecedented access” to information on services delivered by individual physicians and certain...more

CMS Releases Physician Medicare Billing Data

The U.S. Department of Health and Human Services (HHS) announced on April 9th a “historic” release of Medicare payment data to provide consumers with “unprecedented transparency on the medical services physicians provide and...more

Department of Health and Human Services to Release Medicare System Data

Last week, the Department of Health and Human Services (HHS) announced that they will begin to publicly release Medicare system data, including payment and utilization rates, for the 880,000 physicians currently participating...more

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

I’ll Be Watching You: Medicare Billing Info on over 880,000 Providers Released by CMS to Improve Transparency

Every payment you take, every claim you make, someone will be watching you. No, we don’t mean Sting. We mean all the consumers and businesses that will have greater access to physician billing information now because today...more

ACA’s Deductible Limits for Small Groups Repealed

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. The primary purpose of the law is to provide a one-year delay of a 24% reduction in payment rates for physicians who participate...more

Number 17: Congress Patches the SGR Yet Again

For the 17th time since the Sustainable Growth Rate (SGR) became law as part of the Balanced Budget Act of 1997, last week the Congress passed a short-term “patch” to prevent scheduled cuts from going into effect for...more

Do you understand the new Medicare surtax?

Here are six simple rules for individual taxpayers to remember - Beginning with tax year 2013, certain individuals, trusts, and estates may be subject to a 3.8% surtax under Section 1411 of the Internal Revenue Code....more

Post-DOMA, IRS and CMS issue further guidance regarding same-sex spouses

Last September, three months after the U.S. Supreme Court issued its landmark decision in United States v. Windsor, the IRS issued some much-anticipated guidance regarding the treatment of same-sex spouses. For employers who...more

CMS Advised to Follow Private Sector Practices to Improve Physician Feedback Reports

On March 26, 2014, the Government Accountability Office (GAO) released its report regarding the private sector’s physician feedback reporting practices and how implementation of such practices could improve CMS’s own reports...more

CMS to Test New Models of Care for Hospice: Summary of the Medicare Care Choices Model

On March 18, 2014, CMS launched an initiative to “develop innovate payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid.”...more

CMS Releases Fiscal Year 2012 Recovery Auditing Report

In a recent report on the Recovery Audit program for fiscal year (FY) 2012, CMS reports that Recovery Auditors identified $2.4 billion dollars in improper payments, including $2.3 billion in overpayments and $109.4 million in...more

HHS Guidance Clarifies that Insurance Companies Must Make Available Health Insurance Coverage for Same-Sex Spouses

On March 14, 2014, the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) released guidance clarifying the final regulations implementing Section 2702 of the Public Health Service Act...more

Five Key Decisions for ACOs Looking to Participate in the 2015 MSSP

The Centers for Medicare & Medicaid Services (CMS) has announced the upcoming deadlines for the third round of new applications to the Medicare Shared Savings Program (MSSP). Accountable Care Organizations (ACOs) that...more

Manatt on Medicaid: The Basic Health Program: New Final Guidance Offers Insight Into Program Rules and Financing

The Patient Protection and Affordable Care Act (ACA) gives states the option to establish a Basic Health Plan (BHP)—an alternative coverage vehicle for lower-income individuals who would otherwise be eligible for Marketplace...more

Health Information Technology Policy Committee Approves MU Stage 3 Recommendations

On March 11, the Health IT Policy Committee (HITPC) voted to approve the meaningful use workgroup’s Stage 3 recommendations. The federal advisory committee’s recommendations will be presented to the Centers for Medicare &...more

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