The Centers for Medicare & Medicaid Services (CMS) is required to make public by September 1 the “maximum fair prices” (MFP) that CMS is setting for the first ten drugs subject to the Medicare Drug Price Negotiation Program...more
Half of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans. This extensive growth, which represents a doubling of MA enrollment since 2010, has been driven in part by an extensive network of insurance agents...more
4/22/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Data Privacy ,
Data-Sharing ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Lead Generators ,
Marketing ,
Medicare ,
Medicare Advantage ,
PHI ,
Third-Party
Obesity is a complex, multifactorial disease that has serious health consequences, affects millions of Americans and drives hundreds of billions of dollars in annual health care spending. Scientific understanding of the...more
9/25/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Food & Drug Regulations ,
Food and Drug Administration (FDA) ,
Health Insurance ,
Healthcare ,
Life Sciences ,
Medicare ,
Medicare Part D ,
Pharmaceutical Industry ,
Prescription Drugs
At 11:59 p.m. on Thursday, May 11, 2023, the COVID-19 public health emergency (PHE) declaration will conclude, more than three years after taking effect in January 2020. The PHE declaration has enabled the U.S. Department of...more
Medicare Advantage (MA) plans now cover about half of Medicare beneficiaries, and with that enrollment growth has come increased scrutiny from federal and state regulators. As federal regulators complete a busy season of...more
3/28/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Continuing Legal Education ,
Enforcement ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Medical Necessity ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Medicare Beneficiaries ,
New Rules ,
Risk Adjustment Formula ,
Webinars
On January 30, the Centers for Medicare & Medicaid Services (CMS) released a long-awaited final rule addressing how it will calculate and collect overpayments from Medicare Advantage (MA) plans arising from risk adjustment...more
Editor’s Note: Approximately 12 million people in the United States are dually eligible for both Medicare and Medicaid. Most dual-eligible individuals live below the poverty line and have complex health needs. Because...more
Approximately 12 million people in the United States are dually eligible for Medicare and Medicaid. Because dual-eligible individuals and health plans serving this population must navigate two disparate coverage programs,...more
The Centers for Medicare & Medicaid Services (CMS) released the final 2023 Notice of Benefit and Payment Parameters (NBPP), the annual rule outlining key policies for the individual and group health insurance markets for plan...more
On February 23, the federal District Court in the Eastern District of Texas struck down key provisions of regulations issued by the federal Departments of Health and Human Services, Labor, and the Treasury (Departments) and...more
The federal Centers for Medicare & Medicaid Services (CMS) has begun publishing on its website letters that it sent to states beginning in December 2021 that provide important information regarding the manner in which the...more
President Biden set an ambitious health care agenda in his campaign and maintained that focus as he took office. The Biden administration has expressed a strong commitment to “protect and build on the Affordable Care Act,...more
2/16/2022
/ Alternative Payment Models (APM) ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Beneficiaries ,
Physicians ,
Public Health Emergency ,
Public Health Insurance Marketplace ,
Surprise Medical Bills ,
Telehealth ,
Webinars
On January 12, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule,...more
1/25/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Drug Pricing ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Medicaid ,
Medical Loss Ratio ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
Prescription Drug Coverage ,
Prescription Drugs
In December 2021, the Centers for Medicare & Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters for 2023. This proposal kicks off the annual rulemaking cycle for the Marketplaces and the...more
Editor’s Note: In this article, Manatt Health provides an update on the latest policy developments around the No Surprises Act (NSA) and the vaccination mandate for health care workers....more
1/19/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Dispute Resolution ,
Employer Mandates ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Healthcare Workers ,
Interim Final Rules (IFR) ,
Out-of-Pocket Expenses ,
Surprise Medical Bills
After a six-month delay due to the COVID-19 pandemic, the first provisions of the interoperability rule issued by the Centers for Medicare & Medicaid Services (CMS) took effect on July 1. The new requirements are the first of...more
7/19/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Data Management ,
Data Protection ,
Data-Sharing ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Reform ,
Medicare Advantage Organizations (MAOs) ,
Price Transparency ,
Qualified Health Plans ,
Regulatory Requirements
Over the past month, there has been significant activity related to the future of requirements that condition Medicaid eligibility on work/community engagement (CE). In both the policy arena and in court, the Trump...more
In 2014, the Centers for Medicare & Medicaid Services (CMS) published a rule instructing MA plans to use “reasonable diligence” to make sure the diagnosis data they submit to CMS is correct. CMS pays MA plans a fixed monthly...more
During the first half of 2018, the Centers for Medicare & Medicaid Services (CMS) granted four states—Arkansas, Indiana, Kentucky and New Hampshire—Section 1115 waivers permitting them to condition Medicaid coverage for...more
On July 20, the Centers for Medicare & Medicaid Services (CMS) issued the new “Medicare Communications and Marketing Guidelines” (MCMG), which governs Medicare Advantage organizations (MAOs) and Part D plan sponsors. The MCMG...more
Editor’s Note: In just the first year of the Trump administration, healthcare faced an avalanche of change. The disputes arising from the flood of new developments encompass both legal and regulatory challenges—and are being...more
The Future of Essential Health Benefits -
Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more
3/24/2017
/ Affordable Care Act ,
Antitrust Immunity ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Essential Health Benefits ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Reform ,
Insurer Liability ,
Medicaid ,
Premiums ,
Repeal ,
Trump Administration
Editor’s Note: This “Manatt on Medicaid” is the fifth in a series of updates focused on CMS’s new Medicaid/CHIP managed care regulations. In the coming weeks Manatt will continue to explore key provisions of the regulations...more
Lessons from Hawaii's Trailblazing ACA 1332 Waiver Proposal -
Editor's Note: On September 9, Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's proposal focuses on the...more
12/22/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Contraceptive Coverage Mandate ,
Department of Health and Human Services (HHS) ,
Freedom of Religion ,
Hospital Mergers ,
IRS ,
Long-Term Care ,
Medicare ,
Medicare Part B ,
OIG ,
Prescription Drugs ,
Public Health Insurance Marketplace ,
SCOTUS ,
Section 340B ,
Split of Authority ,
Stark Law ,
Waivers
On May 26, 2015, the Centers for Medicare and Medicaid Services (CMS) released a notice of proposed rulemaking (NPRM) to overhaul the regulations governing Medicaid managed care and make conforming changes to the rules that...more
6/13/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Grievance Process ,
Managed Care Contracts ,
Medicaid ,
Medical Loss Ratio ,
Medicare ,
Medicare Advantage ,
NPRM ,
Prescription Drug Coverage ,
Quality of Care Standards