Medicare Advantage

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

by Roy M. Albert, Susan Berson | Mintz Levin - Health Law on 5/22/2013

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

Supreme Court Denies Certiorari in MAO’s Double Damages Case

by Edward Waller | Fowler White Boggs P.A. on 5/3/2013

On April 15, 2013, the United States Supreme Court denied a petition for certiorari brought by GlaxoSmithKline (“Glaxo”) seeking review of a Third Circuit decision in favor of Humana Medical Plan (“Humana”), as a Medicare...more

Significant Proposed Changes for Federal Health Care Programs in President’s Fiscal Year 2014 Budget Plan

by Elizabeth K. Isbey, Eric Zimmerman | McDermott Will & Emery on 4/19/2013

On April 10, 2013, President Obama released his budget proposal for fiscal year (FY) 2014 (the Budget). The President reiterated his long-standing goal of reducing the deficit by $4.3 trillion over 10 years and his...more

Health Reform + Related Health Policy News Update - April 2013

by Jane Arnold, Anika Clifton, Thomas Donohoe, Colleen M. Faddick, Matthew Murer, Alan K. Parver, Emily Wey | Polsinelli on 4/17/2013

In this Issue: - Top News ..Large Hospital Systems Settles for $25.5 Million for False Claims Act Allegations ..Catholics’ Challenge to Contraceptive Coverage Mandate Dismissed As Not Ripe - States...more

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

by Roy M. Albert, Theresa C. Carnegie, Tara Swenson | Mintz Levin - Health Law on 4/17/2013

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

Health Care Reform Implementation Update - April 12, 2013

by Mark Alderman | Cozen O'Connor on 4/12/2013

While Congress was in recess, the Centers for Medicare and Medicaid Services (CMS) surprised many when it changed course on Medicare Advantage payment rates – switching from a 2.3 percent reduction to a 3.3 percent increase,...more

CMS Announces CY 2014 MA and Part D Rates with Change to Growth Rate Estimates

by Jeremy Earl, Anne W. Hance | McDermott Will & Emery on 4/5/2013

The Centers for Medicare & Medicaid Services (CMS) released the announcement of CY 2014 payment rates on April 1, which included its change in position regarding the assumption of the "doc fix" in estimates of Medicare...more

Court of Appeals Rules for Government in DSH Exhausted Benefit Day Appeal

by Thomas W. Coons | Ober|Kaler on 4/5/2013

For the last several years, hospitals and the government have fought hard over where days associated with certain “dual eligible” patients should be placed in the Medicare disproportionate share hospital (DSH) calculation. At...more

CMS Publishes 2014 Final Call Letter

by Tara Swenson | Mintz Levin - Health Law on 4/2/2013

Yesterday, CMS released its 2014 Final Call Letter for the Medicare Advantage and Medicare Part D programs....more

GAO Report Finds that CMS Overpaid Medicare Advantage Plans in 2010, 2011 and 2012

by King & Spalding on 3/14/2013

On March 4, 2013, the GAO released a report titled, Substantial Excess Payments Underscore Need for CMS to Improve Accuracy of Risk Score Adjustments, in which the GAO concluded that CMS overpaid Medicare Advantage plans (MA)...more

CMS Releases 2014 Advance Notice and Proposed MA and Part D Program MLR Regulations

by Jeremy Earl, Ankur Goel, Anne W. Hance | McDermott Will & Emery on 2/25/2013

On February 15, 2013, the Centers for Medicare & Medicaid Services released for comment two key documents affecting the Medicare Advantage (MA) and Part D Programs: (1) the Advance Notice of Methodological Changes for...more

CMS Announces Proposed Rule Implementing the ACA's MLR Requirements for MA and Prescription Drug Plans

by Darryl Landahl, Ishra Solieman | Brownstein Hyatt Farber Schreck on 2/22/2013

On February 15, the Centers for Medicare & Medicaid Services (CMS) released its Proposed Rule, effective calendar year (CY) 2014, implementing the Medical Loss Ratio (MLR) requirements for Medicare Advantage (MA)...more

Health Care Reform Implementation Update - February 19, 2013

by Mark Alderman | Cozen O'Connor on 2/19/2013

Last week another marketplace deadline came and went, Illinois became the 21st state approved to operate a health insurance marketplace, and U.S. senators pressed the HHS official responsible for the bulk of exchange...more

Healthcare Sector Under Scrutiny: Congressional Oversight of the Affordable Care Act by Daniel F. Donovan and William Clarkson

by King & Spalding on 2/5/2013

"I've long maintained that there are three possible routes to repeal of ObamaCare: the courts, the presidential election, and our constitutional responsibility for oversight. With two of them having come up short, the third...more

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