Mary Moll Alexandre at McDermott Will & Emery

[Event] Value-Based Care Symposium 2024 - May 16th - 17th, Nashville, TN

WHERE VALUE-BASED CARE MEETS THE BUSINESS OF HEALTHCARE - Join hundreds of c-suite leaders, investors, operators and counsel in the healthcare capital of the United States for a deep dive into the key business and policy...more

CMS Releases Guidance on Coverage Criteria, Use of AI and More

On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) related to Medicare Advantage (MA) coverage criteria and utilization management (UM) requirements....more

2/20/2024 / Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare , Healthcare Reform , Medicare Advantage , New Guidance , Regulatory Requirements

CMS Proposes to Prohibit Overrides in Medicare Advantage

On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding Contract Year (CY) 2025 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug...more

11/10/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Managed Care Contracts , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D , Proposed Rules

[Webinar] The Rise of the Payvider: Joint Ventures Between Health Systems and Payors - October 19th, 1:00 pm - 2:00 pm EDT

The emergence of joint ventures between health systems and payors is quickly reshaping the healthcare sector as we know it—presenting both new complexities and fresh opportunities for the changemakers involved....more

CMS Issues Medicare Drug Price Negotiation Initial Guidance, First Inflation Rebate List

On March 15, 2023, the Centers for Medicare and Medicaid Services (CMS) issued initial program guidance related to implementation of the Medicare Drug Price Negotiation Program. CMS requested public comments on selected...more

4/5/2023 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Inflation Reduction Act (IRA) , Medicare , Medicare Part B , New Guidance

[Event] Digital Health Forum 2023 - May 17th - 18th, New York, NY

Building on the success of our inaugural conference, McDermott’s Digital Health Forum is back! Join senior leaders transforming digital health for ample networking opportunities and robust panel discussions on the business,...more

4/4/2023 / Best Practices , Business Development , Business Model , Business Operations , CEOs , Collaboration , Continuing Legal Education , Digital Health , Diversity , Events , Founding Members , Health Care Providers , Health Technology , Healthcare Facilities , Investors , Partnerships

CMS Updates COVID-19 Guidance for MA Organizations and Part D Sponsors, Addresses the Status of Telehealth Visits for Risk...

Since early March 2020, the Centers for Medicare and Medicaid Services (CMS) has released a steady stream of guidance to Medicare Advantage Organizations (MAOs) and Part D sponsors in connection with the Coronavirus...more

5/5/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Plan Sponsors , Medicare Advantage Organizations (MAOs) , Medicare Part D , New Guidance , Telehealth

CMS Seeks to Provide Flexibility and Facilitate Innovation in Medicare Advantage and Part D

The Centers for Medicare and Medicaid Services (CMS) recently released several significant Medicare Advantage (MA) and Part D guidance documents outlining new Center for Medicare and Medicaid Innovation (CMMI) programs and...more

2/8/2019 / Advance Notice , Bipartisan Budget Act , Call Letter , Centers for Medicare & Medicaid Services (CMS) , CMMI , GAO , Medicare Advantage , Medicare Part D , Opioid , Prescription Drugs , Risk Adjustment Formula , Social Security Act

Administration Offers Up New Proposals to Cut Drug Costs

On November 26, CMS released a notice of proposed rulemaking, “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses,” which includes provisions that aim to reduce overall drug...more

12/3/2018 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Life Sciences , Medicaid , Medicare Advantage , Medicare Part B , Medicare Part D , Pharmaceutical Industry

CMS Proposes New Telehealth Guidelines and RADV Extrapolation for MAOs

On October 26, 2018, CMS released a Notice of Proposed Rulemaking addressing expanded telehealth coverage in Medicare Advantage, extrapolation of RADV audit results, and updates to the Medicare Advantage and Part D Quality...more

11/2/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare Advantage Organizations (MAOs) , Notice of Proposed Rulemaking (NOPR) , Telehealth

Flurry of Medicare Advantage and Part D Changes Includes Significant Policy Shifts

Last week, CMS released new regulations and guidance for Medicare Advantage Organizations (MAOs) and Part D Sponsors. These documents—along with the Bipartisan Budget Act of 2018 that was passed in January—reflect significant...more

4/13/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage Organizations (MAOs) , Medicare Part D

CMS Encourages Innovation in MA, Asks Part D Plans to Combat Opioid Overuse, and Fine-Tunes Payments

The Centers for Medicare & Medicaid Services (CMS) has released its annual payment and policy guidance for Medicare Advantage and Part D plans. CMS is continuing to find ways to inject more flexibility into these programs,...more

2/7/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare Advantage , Medicare Part D

Final Policies on Encounter Data and the Star Ratings Released

The Centers for Medicare and Medicaid Services recently finalized meaningful Medicare Advantage policy changes in response to industry concerns, including those regarding data integrity, the Star Ratings and encounter data....more

4/6/2017 / Centers for Medicare & Medicaid Services (CMS) , Data Collection , Medicaid , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Risk Adjustment Formula , Star Ratings

Medicare Advantage Draft Call Letter Addresses Encounter Data, Star Ratings

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released proposed updates to the Medicare Advantage (MA) and Part D programs through the CY 2018 Advance Notice and Draft Call Letter. Despite largely...more

2/8/2017 / Centers for Medicare & Medicaid Services (CMS) , Enforcement , Medicaid , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D

21st Century Cures: A Closer Look

On December 7, 2016, the US Congress enacted the 21st Century Cures Act, substantial legislation intended to accelerate “discovery, development and delivery” of medical therapies by encouraging biomedical research investment,...more

21st Century Cures: Congress Enacts Medicare Advantage and Small Business Insurance Market Reforms

The 21st Century Cures Act encourages biomedical research investment and facilitates innovation review and approval processes, but also serves as a vehicle for a wide variety of other health-related measures, including...more

12/12/2016 / 21st Century Cures Initiative , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , ESRD , Handbooks , HRA , Medicare Advantage , Open Enrollment , Risk Assessment , Star Ratings

CMS Releases Plan for Expanded Monitoring of Medicare Advantage and Part D Appeals and Grievances

In Depth - The Centers for Medicare & Medicaid Services (CMS) recently announced that it will monitor—beginning in January 2017—Part C and D appeals timeliness on an industry-wide basis. Under this initiative, all...more

12/6/2016 / Centers for Medicare & Medicaid Services (CMS) , Health Plan Sponsors , Medicare Advantage , Medicare Part D

CMS’s Final Medicaid Rule Creates a Medicaid MLR Framework but Leaves Room for State Variation

In Depth - The final Medicaid managed care rule issued by the Centers for Medicare & Medicaid Services (CMS) on April 25, 2016, (the Final Rule) establishes a new federal medical loss ratio (MLR) standard for Medicaid...more

5/12/2016 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Managed Care Contracts , Medicaid , Medical Loss Ratio

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

5/4/2016 / Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Advantage , Payment Methods , Provider Payments

Preview of Medicare Advantage and Part D Advance Notice and Call Letter: CMS Likely to Address Risk Adjustment, Provider Network,...

The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year (CY) 2017. The...more

2/10/2016 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Fee-for-Service , Health Care Providers , Medicare Advantage , Medicare Part D , MedPAC , Recovery Audit Contractors (RACs) , Star Ratings

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

2/25/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Healthcare Reform , Home Health Care , Medicare Advantage

CMS Proposed Rule Would Modify Risk Adjustment Data Collection, Data Validation Audits with Some Material Effects

The Centers for Medicare & Medicaid Services’ proposal for risk adjustment data collection demonstrates the agency’s continued concern that Medicare Advantage Organizations’ activities are resulting in more “intense” coding,...more

1/29/2014 / Audits , Centers for Medicare & Medicaid Services (CMS) , Data Collection , Healthcare

Mary Moll Alexandre

McDermott Will & Emery

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