Medicare Advantage

News & Analysis as of

Health Headlines: Also in the News - September 2014

GAO Finds CMS Should Fully Develop Plans for Medicare Advantage Encounter Data and Assess Data Quality Before Use – In a report released on September 2, 2014, GAO evaluated CMS’s plans for using Medicare Advantage (MA)...more

CHI Takes the Plunge into the Insurance Business

For several years now hospital systems have been tip-toeing around the business of health insurance. They’ve been signing up for Medicare Advantage plans, taking on more and more risk, managing care and raiding health...more

Health Headlines: Also in the News - July 2014 #3

CMS Revises Medicare Advantage and Part D Prescription Drug Plan Prior Authorization Requirement for Hospices – On July 18, 2014, CMS released a revised a memorandum outlining responsibility for drug payments for hospice...more

Health Care Reform Implementation Update - July 2014

On June 30, in one of the most highly anticipated cases affecting the Affordable Care Act (ACA), the Supreme Court ruled that closely held companies could assert a “religious objection” to the ACA contraceptive coverage...more

CMS Releases CY 2015 OPPS and ASC Proposed Rule

On July 3, 2014, CMS released the CY 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. In its proposal, CMS seeks, among other things, to increase...more

Health Headlines: Also in the News - June 2014 #4

CMS Holds Medicare Advantage and Prescription Drug Oversight and Enforcement Conference – On June 24, 2014, CMS offered an in-person program that instructed Medicare Advantage and Part D providers as to how they could...more

The SEC v. Congress . . . for the Title

You don’t see this every day. On Friday, the SEC filed a subpoena enforcement action seeking production of documents from the House Ways and Means Committee and documents and testimony from one of its staff members, Brian...more

Insurance carrier ending coverage of physicians under Medicare Advantage contracts

Physicians, healthcare providers, insurers and other interested parties should be aware that a large insurance carrier operating Medicare Advantage plans in Missouri and Illinois recently has begun terminating its...more

No More He-Said-She-Said: Revised Regulations Allow CMS to Request Records Information Directly from any Person or Entity Involved...

The Centers for Medicare & Medicaid Services (CMS) on May 19, 2014, adopted a final rule that significantly revised Medicare Advantage (MA) and Part D prescription drug benefit program regulations (the “Final Rule”). One of...more

CMS Announces Final Regulatory Changes to Medicare Advantage and Part D

- CMS issues final Medicare Advantage and Part D regulatory changes after a controversial proposed rule was announced earlier this year. - New requirements for the reporting and return of Medicare Advantage and Part D...more

CMS Changes to Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015

On May 19, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule, published in the Federal Register on May 23, 2014, that sets forth changes to requirements for Medicare Advantage (“MA”) and...more

CMS Issues Pared-Down Final Rule on Medicare Part D and Medicare Advantage

CMS recently issued a Final Rule with respect to the Medicare Part D and Medicare Advantage programs (the “Final Rule”) implementing certain Affordable Care Act provisions. The Final Rule follows a January 10, 2014 Notice of...more

CMS Scaled Back Changes to the Medicare Part D Prescription Drug and Medicare Advantage Programs, but Some Important Revisions...

On May 19, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule ("Final Rule") completing changes to the Medicare Program's outpatient prescription drug benefit ("Part D") program and the Medicare...more

Federally Qualified Health Centers: Welcome to PPS

CMS recently finalized a new PPS for Federally Qualified Health Center (FQHC) services. The implementation of the PPS was mandated by the ACA. Medicare currently pays FQHCs an all-inclusive rate for the professional...more

CMS Proposes Rule That Would Expand Its Authority To Audit Medicare Advantage Plans

On April 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule to update payment policies and rates for inpatient hospitals (the “Proposed Rule”) that includes a provision with significant...more

CMS Further Clarifies that Contract Language Determines Whether Sequestration Adjustments Apply to Part C Provider Payments

In an April 17, 2014 letter to the American Hospital Association, CMS Administrator Marilyn Tavenner stated that whether “sequestration might affect a [Medicare Advantage plan’s] payments to its contracted providers [is]...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

Health Care Update

In This Issue: - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other Health Care News - Upcoming Hearings and...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

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

OIG Issues Compendium of Unimplemented Priority Recommendations

On March 18, 2014, the OIG released its Compendium of Priority Recommendations (Compendium), which lists 25 broad “Priority Recommendations” for achieving “cost savings, improve program management, and ensure quality of care...more

CMS Abandons Certain Controversial Provisions in its Proposed Medicare Part D Rule

Following an onslaught of criticism, CMS told Congress today that it will not move forward with certain controversial provisions of its proposed rule on the Medicare Advantage and Medicare Part D prescription drug program. ...more

Health Care Reform Implementation Update - February 26, 2014

Though Congress was in recess this past week, congressional staff was hard at work continuing to consider ways to prevent a cut to Medicare providers’ payment rates that will be triggered by the sustainable growth rate...more

CMS Announces 2015 Rate Cut for Medicare Advantage Plans

On February 21, 2014, CMS released an Advance Notice estimating a decline of 1.9% in 2015 payments for Medicare Advantage (MA) plans. The preliminary estimate of the decline is based on the per capita MA growth percentage,...more

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