News & Analysis as of

Medicare Advantage

Medicare Advantage Enrollment Growth by Region (2008-17)

For the past decade, Medicare Advantage (MA) plans added nearly 10 million members. In 2017, one-third of Medicare beneficiaries nationally had enrolled in MA plans. Western states embraced MA early, with nearly one-third of...more

CMS Expands Health Related Supplemental Benefits in Medicare Advantage Plans

by Dorsey & Whitney LLP on

Last month, the Centers for Medicare and Medicaid Services (“CMS”) announced new flexibility in what Medicare Advantage plans may cover as “supplemental health care benefits.” The announcement was part of CMS’ release of...more

Who Pays? The Promise of Telehealth, Part II in a Series Addressing the Role of Telehealth in the Delivery of Health Care in New...

by Hodgson Russ LLP on

Advances in telecommunications, including improvements in high resolution imaging and access to broadband, are accelerating the availability of telehealth. Still, an important question remains: who pays for telehealth...more

California Court Of Appeal Holds That Disclosure Of Confidential Information Protected By Anti-SLAPP Statute

by Seyfarth Shaw LLP on

A recent California Court of Appeal decision held that the receipt, retention and dissemination of confidential information by a whistleblower’s attorney is protected by the state’s anti-SLAPP statute. MMM Holdings, Inc. v....more

CMS Seeks Input on Direct Provider Contracting

The Centers for Medicare & Medicaid Services (CMS) announced that it is seeking input on direct provider contracting (DPC) between “payers and primary care or multi-specialty groups to inform potential testing of a DPC model”...more

Capitol Hill Healthcare Update

by BakerHostetler on

GOP LAWMAKERS: EUROPE, CANADA ‘FREE RIDING’ ON US DRUG INNOVATION - More than two dozen House Republicans last week called on President Donald Trump to leverage upcoming trade negotiations to stop other nations from “free...more

Blue Shield of California Notifies Insureds of Disclosure of PHI to Insurance Broker

According to a notification letter sent to an unknown number of patients, Blue Shield of California (Blue Shield), “shared” the protected health information of members with an insurance broker who was not supposed to receive...more

CMS Aims to Decrease Burdens and Increase Innovation in Medicare Parts C and D With New April 2018 Guidance

by BakerHostetler on

In regulations published on April 16, 2018, the Centers for Medicare & Medicaid Services (CMS) issued two new documents containing guidance primarily on the Medicare Advantage (MA) program and on the Medicare prescription...more

Medicare Advantage to Address Social Determinants of Health: An Important Step for Value-Based Care

On April 4, 2018, the Centers for Medicare & Medicaid Services (“CMS”) finalized guidance and policies for the Medicare Advantage program that will expand the supplemental benefits afforded to beneficiaries to include items...more

California: Proposed Legislation Regulating Health Care Rates for Payors and Providers

by Foley & Lardner LLP on

An ambitious California proposal to regulate health care rates and curb long-term health care spending was unveiled last week in Assembly Bill 3087 (Proposed Legislation). The key concept in the Proposed Legislation is the...more

K&L Gates Triage: Ride Sharing and Health Care Regulatory Considerations

by K&L Gates LLP on

Transportation is often cited as one of the top barriers to health care for individuals in the United States. To reduce this burden and increase access to care, many health care providers are now partnering with ride-sharing...more

Federal Telehealth Policies Summary

by Holland & Knight LLP on

On Feb. 9, 2018, Congress passed and President Donald Trump signed into law the Bipartisan Budget Act of 2018 (BBA). This wide-reaching legislation enacts major changes for telehealth policy in Medicare by incorporating...more

CMS Issues Updated Medicare Payment and Billing Policies for 340B Hospitals

by Baker Ober Health Law on

On April 2, 2018, CMS issued updated guidance related to the dramatic Medicare payment reductions that went into effect this year for certain 340B hospitals. The guidance explains the planned application of the payment cuts...more

Star Ratings and Future Measurement Concepts in the CY 2019 Final Call Letter

Medicare Part C and Part D Star Ratings are used by CMS to measure the quality of and reflect the experiences of beneficiaries in Medicare Advantage (“MA”) and Prescription Drug Plans (“PDPs”). Below is a summary of CMS’...more

New CMS Medicare Advantage Policy Could Have Significant Impact on Senior Living and In-Home Care Providers

by Arnall Golden Gregory LLP on

A Centers for Medicare & Medicaid Services (CMS) call letter (the “Call Letter”) released on April 2, 2018, could mean a dramatic and positive shift in CMS policy related to Medicare Advantage (MA) plans and senior living and...more

CMS releases Medicare Advantage/Part D final rule

by Hogan Lovells on

On April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released a final rule to revise regulations and clarify program requirements within the Medicare Advantage (MA) and the Prescription Drug Benefit (Part D)...more

CMS Updates Medicare Advantage and Part D (Prescription Drug Benefit)

On April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule, updating Medicare Advantage (MA) and the prescription drug benefit program (Part D). ...more

Alston & Bird Healthcare Week in Review

by Alston & Bird on

Alston & Bird’s Week in Review provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and Congressional committee action; reports, studies, and analyses; and other health...more

CMS Releases 2019 MA and Part D Final Rules and Call Letter

Earlier this week, CMS released both the Contract Year 2019 Final Rules for Medicare Advantage and Part D (Final Rules) and the 2019 Call Letter. CMS also released fact sheets for the Final Rule and the Call Letter. The Final...more

The Bipartisan Budget Act – Greater Access, Innovation, and Technology in the Administration of Medicare Advantage Plans - Part I

by Nossaman LLP on

Prior to adjourning for spring recess, Congress passed and the President signed into law on March 23, 2018, omnibus appropriations legislation that funds the government for the remainder of the fiscal year – through September...more

MedPAC Report: A Wake Up Call For Telehealth

by Cozen O'Connor on

The recent Medicare Payment Advisory Commission (“MedPAC” or “Commission”) report should serve as a shot across the bow to telehealth advocates seeking broader Medicare coverage of telehealth. In reading the telehealth...more

Ruling: Medical Providers Not Subject to Double Damages Under Medicare Secondary Payer Act

by Holland & Knight LLP on

• In a matter of first impression, the U.S. District Court for the Middle District of Florida has ruled that a private right of action under the Medicare Secondary Payer Act (MSP Act), which provides for double damages in the...more

CMS’s Advance Notice and Call Letter: How Medicare Plans Can Report, Identify, and Address the Opioid Epidemic

CMS has slowly but surely been providing additional guidance to Medicare Plans (Medicare Advantage and Part D plans) regarding steps they can and should take to address the opioid epidemic as it relates to their...more

Expanded coverage of telehealth

by Hogan Lovells on

The recently enacted Bipartisan Budget Act of 2018 expands Medicare’s coverage for telehealth services in several ways. Inclusion of these provisions, which had been part of a Senate bill called the CHRONIC Care Act, is...more

Federal Court Allows False Claims Act Case to Continue Against Medicare Advantage Insurer

by Holland & Knight LLP on

In February of 2018, a United States District Court in the Central District of California dismissed only half of the claims in a qui tam case against United Health Group, Inc. (UHG), a Medicare Advantage plan provider. United...more

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