Each year, the health plans that participate in Medicare Advantage (MA) program compete vigorously for new members. This vigorous competition has fueled the program’s 10% annual growth rate in recent years. MA plans can...more
On June 9, 2021, Arnold Ventures, researchers from the Boston University School of Public Health and Faegre Drinker hosted a virtual event to explore the issue of fraud in substance use disorder (SUD) treatment. In response...more
Medicare Advantage (MA) is the rapidly growing private plan option in the Medicare program. More than one-third of all Medicare beneficiaries choose MA — more than 24 million people. The program has grown nearly 10% year over...more
On June 3, the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced long-awaited policies to address the impact of COVID-19 on its ongoing models, as well...more
Over the last five years, clinicians, health plans and policymakers have ramped up their focus on the social determinants of health (SDOH). SDOH are non-medical factors (food security, housing security, reliable access to...more
New payment models – both voluntary and mandatory – are on the way for Medicare-participating providers treating kidney disease and offering radiation oncology services.
On July 10, the White House, in conjunction with the...more
On April 24, Centers for Medicare and Medicaid Services (CMS) issued a memo to Medicare Advantage (MA) plan sponsors detailing the scope of Special Supplemental Benefits for the Chronically Ill (SSBCI). Established by the...more
On April 22, The Center for Medicare and Medicaid Innovation (the Innovation Center) at the Centers for Medicare and Medicaid Services (CMS) announced a new Primary Cares Initiative, with two new payment models aimed at...more
Medicare Advantage, the private plan option in the Medicare program, is growing rapidly. Currently, 22 million people choose Medicare Advantage — more than one third of people with Medicare — and that number is expected to...more
The opioid epidemic is causing a rise in the number of treatment centers and recovery residences that offer services for people with substance use disorder (SUD). SUD treatment and recovery entities are less regulated than...more
On November 13, 2017, the Centers for Medicare & Medicaid Services (CMS) announced its Risk Corridors payment and charge amounts for the 2016 benefit year. This event is significant in that it both acknowledges and quantifies...more
Recently, the Centers for Medicare & Medicaid Services (CMS) released its draft 2019 Medicare Advantage application. Health plans seeking to participate in the Medicare Advantage (MA) program for the first time or expanding...more
On May 30, the Department of Justice (DOJ) announced that it reached a settlement with commonly-owned Freedom Health Inc. and Optimum Healthcare, Inc. (Freedom Health) — two Tampa, Florida, managed care plans — to settle...more
On January 9, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) took action against a health system for non-timely reporting of a breach of protected health information. It was the first...more
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/ Breach Notification Rule ,
Corrective Actions ,
Cybersecurity ,
Data Breach ,
Data Protection ,
Data Security ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
OCR ,
PHI