Medicare Advantage

News & Analysis as of

Health Update - June 2016

Real-Time Data Analytics in Government Investigations and Reducing Exposure - It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more

Broad Examination of Narrow Networks: First-of-Its-Kind Study Examines Hospitals in Medicare Advantage Plans

On June 20, 2016, The Kaiser Family Foundation issued the first ever broad-based study of Medicare Advantage hospital networks. The study — "Medicare Advantage Hospital Networks: How Much Do They Vary?"— analyzed 409 plans in...more

All About APMs: What Will It Take for Physicians to Earn the APM Bonus Under MACRA?

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

House Approves “Helping Hospitals Improve Patient Care Act of 2016”

The House of Representatives has approved H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016,” as amended by the Ways and Means Committee in May. As previously reported, while the bill focuses on Medicare...more

Ways and Means Committee Approves Bill to Make Reforms to Medicare Hospital and Other Payment Policies

The House Ways and Means Committee has approved an amended version of H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016.” While most of the provisions address Medicare payment policies pertaining to...more

OIG, GAO Examine Medicare & Medicaid Program Integrity/Provider Screening Issues

The HHS Office of Inspector General (OIG) and the Government Accountability Office (GAO) have recently examined a number of Medicare and Medicaid provider screening and related program integrity issues....more

No More Bidding – CMS 2, EGWPs 1

This Spring, CMS informed MAOs that offer Medicare Advantage EGWPs (employer group waiver plans) that they were no longer required to submit annual bids for EGWPs. Based on CMS’s explanation of why it adopted this change, it...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On May 6, 2016, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule entitled, “Patient Protection and Affordable Care Act; Amendments to Special...more

CMS Finalizes Major Reforms of Medicaid/CHIP Managed Care Rules

On May 6, 2016, CMS is publishing a final rule to update Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to more closely align with Medicare Advantage (MA) and private health plan standards,...more

MA Changes Shift Funding and Add Uncertainty to Already Complex Payment Methodologies

In Depth - The Centers for Medicare & Medicaid Services has enacted significant changes to Medicare Advantage (MA) payment methodologies that will shift payment towards MA organizations (MAOs) enrolling significant...more

CMS publishes final Medicaid managed care rule

On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released its long-awaited Medicaid managed care Final Rule, the first update to Medicaid managed care regulations since 2002, and implements dozens of...more

CMS Issues Final 2017 Medicare Advantage Capitation Rates and Medicare Advantage/Part D Payment Policies

CMS has issued its final 2017 Medicare Advantage (MA) and Part D Rate Announcement and Call Letter, which includes a series of policy and payment changes related to these programs. CMS estimates that the final policies will...more

Washington Healthcare Update

This Week: MedPAC votes on changes in Part D... Senate HELP Committee reports five “Cures” bills... One report shows uninsured number decreasing... Another says, but we still need the safety net. ...more

Blog: Washington Update: Senate proceeds towards “Cures”; CMS releases MA rates and Call Letter

Health care policy issues continue to stream out of Congress and the Administration. The Senate held a markup of various health bills as part of its effort to produce a companion to the House of Representatives-passed 21st...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 4, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the Final Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage (MA) and...more

Health Care Congressional Outlook for the Spring Word Period

The next work period basically runs from April 4 to May 27, with both chambers adjourning for a week long recess the week of May 2. Following this work period, there will be five weeks left on the legislative calendar before...more

CMS Seeks Input on Medicare’s Value-Based Insurance Design Model

Last week, CMS asked Medicare Advantage Organizations for feedback on the Medicare Advantage Value-Based Insurance Design model test that will begin on January 1, 2017....more

MedPAC Releases Annual Recommendations to Congress on Medicare Policy

The Medicare Payment Advisory Commission (MedPAC) has released its annual recommendations to Congress on Medicare policies, including Medicare fee-for-service (FFS) payment updates and a status report on the Medicare...more

CMS Changes Policy Related to Medicare Advantage Plan Star Ratings and Sanctions

In a brief memorandum dated March 8, 2016 (available here), CMS announced the suspension of its policy providing for automatic reduction of star ratings for Medicare Advantage plans operating under a CMS-imposed intermediate...more

Your Right to Refills If Medicare Drops Coverage of Your Drugs

Medicare prescription drug plans can change which drugs they cover, leaving you without coverage for a drug you need. Or you may switch plans into a plan that doesn't cover your medication. In these circumstances, Medicare...more

CMS Releases 2017 Advance Notice and Draft Call Letter

Last week, the Centers for Medicare & Medicaid Services (CMS) released its 2017 Advance Rate Notice and draft Call Letter (“2017 Draft Call Letter”) for the Medicare Advantage (“MA”) and Part D programs. With the final 2017...more

CMS Proposes Rate, Policy Updates for Medicare Advantage and Prescription Drug Plans

CMS has issued its draft 2017 Medicare Advantage (MA) and Part D Advance Notice and Draft Call Letter, which includes a variety of proposed policy changes and rate updates related to these programs. CMS estimates that the...more

Significant Telehealth Expansion Proposed in Bipartisan Senate Bill

Earlier this month, a bipartisan group, led by U.S. Senator Brian Schatz (D-Hawaii), introduced a bill in the Senate focused on promoting cost savings and quality care under the Medicare program through the use of telehealth...more

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

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