Jeffrey Davis on Medicare Advantage

An MA Extravaganza: Overview of the Final Rule and Rate Announcement

This past week, the Trump administration put its first major stamp on the Medicare Advantage (MA) program. The Centers for Medicare & Medicaid Services (CMS) released two final regulatory documents related to MA: - The...more

4/10/2025 / Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Final Rules , Healthcare , Healthcare Reform , Inflation Reduction Act (IRA) , Medicare Advantage , Medicare Part D , Pharmaceutical Industry , Prescription Drugs , Regulatory Requirements , Risk Management , Rulemaking Process , Technology Sector

2026 Medicare Advantage and Part D Final Rate Notice: What to Expect

Key Takeaways - - CMS is expected to issue the 2026 final rate notice for Medicare Advantage (MA) and Part D plans by April 7, 2025. - The January 2025 advance notice proposed policies that would increase payments to MA...more

3/26/2025 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Advantage , Medicare Part D , Prescription Drugs , Proposed Rules , Regulatory Agenda , Risk Management , Trump Administration

CY 2026 MA and Part D Final Reg: Policies Under Consideration

Last week, the contract year (CY) 2026 Medicare Advantage (MA) and Part D final reg entered the clearance process at the Office of Management and Budget (OMB). As mentioned in a previous Regs & Eggs blog post, OMB’s review is...more

3/13/2025 / Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Inflation Reduction Act (IRA) , Medicaid , Medicare , Medicare Advantage , Medicare Part D , Medicare Payment Reform , Mental Health , OMB , Pharmaceutical Industry , Prescription Drugs , Prior Authorization , Proposed Rules , Technology , Utilization Review

The Future of Medicare Advantage: Q&A with McDermott+’s Lynn Nonnemaker

A few weeks ago, Regs & Eggs provided insights into Medicare Advantage (MA), the private insurance option under Medicare, and explored both short- and long-term actions that the Trump administration could take to modify MA...more

2/13/2025 / Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare , Healthcare Reform , Insurance Industry , Medicare , Medicare Advantage , Medicare Part D , Proposed Rules , Regulatory Agenda , Trump Administration

Outlook for Medicare Advantage Under the Trump Administration

Medicare Advantage (MA), the private insurance option under Medicare, is one of many policy areas that will garner great attention in 2025 and beyond under the incoming Trump Administration. We recently released our 2025...more

1/16/2025 / Centers for Medicare & Medicaid Services (CMS) , Enrollment , Final Rules , Health Insurance , HRA , Legislative Agendas , Medicare , Medicare Advantage , Proposed Rules , Trump Administration

No Doc Fix or Advanced APM Bonus: What Happens Next?

Here we go again! For the second year in a row, we enter the new year without Congress enacting a doc fix or Advanced Alternative Payment Model (APM) bonus extension. While Congress did act last year on both counts (through...more

1/9/2025 / Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare Reform , Medicare , Medicare Advantage , MIPS , Physicians , Value-Based Care

Regs Coming Through the End of the Year: Expect the Expected and the Unexpected

There could be an all-you-can-eat buffet of regs (and eggs) from now until the end of the year! As you may recall, a July 2024 Regs & Eggs blog post highlighted the spring 2024 “unified agenda” that listed all the regs...more

10/17/2024 / Biden Administration , Billing , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Dispute Resolution , Health Care Providers , Health Insurance , Healthcare , Healthcare Reform , Legislative Agendas , Medicare Advantage , Proposed Regulation , Regulatory Agenda , Regulatory Standards

Regs, Regs and More Regs: The Biden Administration Releases Spring 2024 Unified Agenda

We are in the midst of a storm of regulations that are being released by the Centers for Medicare & Medicaid Services (CMS) and the US Department of Health and Human Services (HHS), including the Calendar Year (CY) 2025...more

7/11/2024 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Health Insurance , Healthcare , Healthcare Reform , Hospitals , Insurance Industry , Legislative Agendas , Medicare Advantage , Popular , Proposed Regulation , Regulatory Agenda

Another News-Filled Medicare Advantage Regulatory Week

Although I previously declared January 2024 Medicare Advantage (MA) Month, this week has also been filled with news about the MA program. The Centers for Medicare & Medicaid Services (CMS) released the final rate announcement...more

4/4/2024 / Centers for Medicare & Medicaid Services (CMS) , Congressional Committees , Health Care Providers , Health Insurance , Healthcare , Legislative Agendas , Medicare , Medicare Advantage , Medicare Part C , Medicare Part D , MedPAC

President Biden Releases FY 2025 Budget: What’s NOT in It?

Earlier this week, President Biden released his Fiscal Year (FY) 2025 President’s Budget. As a reminder, every year, the White House releases a budget that serves as its official funding request to Congress for the following...more

3/14/2024 / Artificial Intelligence , Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Executive Orders , Federal Budget , Healthcare , Medicaid , Medicare , Medicare Advantage , Medicare Part A , Medicare Part B , MedPAC , Mental Health , Pharmacy Benefit Manager (PBM) , Physician Fee Schedule , Public Health Emergency , Transparency

The Doctor (Fix) Is In: Regulatory Implications of the Minibus Healthcare Package

Last Sunday, Congress released the text of a minibus package, which will likely be signed into law by tomorrow. While the bill’s primary purpose is to keep the government open, it also includes healthcare extenders through...more

3/7/2024 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Congressional Committees , Healthcare , Healthcare Reform , Legislative Agendas , Medicaid , Medicare Advantage , New Legislation , New Regulations , Payment Systems , Regulatory Agenda

Prior Authorization in Traditional Medicare: Yes, It Exists

When stakeholders think about prior authorization in the Medicare program, they usually focus on its use in Medicare Advantage (MA), and not how it is used in traditional Medicare. In fact, a few weeks ago, the Centers for...more

2/22/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Healthcare , Medicare , Medicare Advantage , Prior Authorization

January 2024: The Month of Medicare Advantage

I, JEFFREY DAVIS, RETROACTIVELY DECLARE THE MONTH OF JANUARY IN THE YEAR 2024 TO BE KNOWN AS “MEDICARE ADVANTAGE MONTH.” Obviously, I don’t have the power to do that, but the health policy community did see a lot of...more

2/8/2024 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Medicare Advantage , Medicare Part D , Price Transparency , Prior Authorization , Utilization Review

Regs During an Election Year: What’s on the Menu?

Last week, McDermott+Consulting launched an election 2024 resource page, where you can find a 2024 health policy outlook and other insights into the November election. While regulations aren’t necessarily top-of-mind when...more

1/25/2024 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Drug Pricing , EMTALA , Health Insurance , Healthcare , Healthcare Reform , Managed Care Contracts , Medicare , Medicare Advantage , Medicare Part D , OMB , Pharmaceutical Industry , Prescription Drugs , Reproductive Healthcare Issues

CMS Issues Two Health Plan Proposed Regs: Different Markets but Similar Policy Goals

Before the Thanksgiving holiday, the Centers for Medicare & Medicaid Services (CMS) issued two proposed regs that would make changes to certain health insurance plan policies starting in 2025: one impacting Medicare Advantage...more

11/29/2023 / Affordable Care Act , Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Health and Welfare Plans , Medicare Advantage , Medicare Part D , Out-of-Pocket Expenses , Pharmaceutical Industry , Proposed Regulation

The Ongoing Poker Game Between Congress and FDA: Who Will Win?

Congress and federal agencies often engage in a game, each trying to see what the other is willing to do to achieve a particular policy or outcome. While Congress and federal agencies have unique authorities (legislative...more

10/5/2023 / Centers for Medicare & Medicaid Services (CMS) , Clinical Laboratories , Congressional Committees , Diagnostic Tests , Food and Drug Administration (FDA) , Laboratory Developed Tests , Legislative Agendas , Life Sciences , Medical Devices , Medicare Advantage , Proposed Rules

Jeffrey Davis

McDermott Will & Emery

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