Medicare Advantage

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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

CMS Proposes to Restrict Diagnoses from Home Visits for Medicare Advantage Risk Adjustment

The Centers for Medicare and Medicaid Services has proposed to limit how Medicare Advantage Organizations can use in-home wellness or risk assessment visits of their enrollees to affect the risk adjusted payments they...more

CMS Proposes Significant Rate Cuts and Other Changes to Medicare Advantage and Prescription Drug Plans

The Advance Notice ("Advance Notice") of Methodological Changes for Calendar Year ("CY") 2015 for Medicare Advantage ("MA") Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter was released by the Centers...more

Health Law Alert - February 2014: Medicare Advantage Terminations: Thinning The Herd Of Qualified Participating Providers

"Thinning the herd" is the process of removing from the population, by any means necessary, those who cannot or should not survive. Emblem, United Healthcare and other major health insurers, have undertaken a corporate...more

CMS Proposes Far-Reaching Changes to the Medicare Part D Prescription Drug Benefit Program and the Medicare Advantage Program

On January 10, 2014, the Centers for Medicare & Medicaid Services ("CMS") published a proposed rule ("Proposed Rule") setting forth sweeping changes to the Medicare Program's outpatient prescription drug benefit ("Part D")...more

Judge Issues Preliminary Injunction Barring UnitedHealthcare from Terminating Certain Physicians From Medicare Advantage Plans

The United States District Court for the District of Connecticut recently granted Fairfield County Medical Association’s and Hartford County Medical Association’s (collectively, the “Associations”) motion for a preliminary...more

Federal District Court Refuses to Dismiss Former Executive’s FCA Complaint Against Medicare Advantage Organization

The United States District Court for the Northern District of California has denied a motion to dismiss the third-amended complaint in a federal False Claims Act (FCA) lawsuit against Kaiser Foundation Health Plan (Kaiser), a...more

HIPAA Marketing Rules Prompt First Amendment Challenge

In what is believed to be the first legal challenge to the HIPAA Omnibus Rule (the “Rule”), a vendor of prescription drug adherence services is seeking an injunction to block certain provisions of the Rule related to drug...more

CMS Conducts Star Ratings Best Practices Webinar

CMS hosted a webinar yesterday focusing on best practices for Medicare Advantage and Prescription Drug Plan Sponsors looking to enhance their Star Ratings. As described in our article and previous blog posts, Star Ratings...more

CMS Issues Final Rule on Medical Loss Ratio for Medicare Advantage and Part D

On May 23, 2013, CMS issued its Final Rule on Medical Loss Ratio (MLR) requirements for Medicare Advantage (MA) and Medicare Part D programs. MLR calculates the percentage of revenue used by MA organizations and Part D...more

Medicare Trustees Project Longer Solvency Period for Hospital Trust Fund

A May 31, 2013 report from the Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds projects that the Medicare Hospital Insurance Trust Fund will remain solvent through FY 2026,...more

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

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

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

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

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

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

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

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