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CMS Announces Participants in Bundled Payment Initiative

The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced the health care organizations chosen to participate in the Bundled Payments for Care Improvement (BCPI) Initiative. The...

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CMS Releases 2014 Advance Notice and Proposed MA and Part D Program MLR...

On February 15, 2013, the Centers for Medicare & Medicaid Services released for comment two key documents affecting the Medicare Advantage (MA) and Part D Programs: (1) the Advance Notice of...

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CMS Announces CY 2014 MA and Part D Rates with Change to Growth Rate Estimates

The Centers for Medicare & Medicaid Services (CMS) released the announcement of CY 2014 payment rates on April 1, which included its change in position regarding the assumption of the "doc fix" in...

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HHS Clarifies that ACA Qualified Health Plans are Not Subject to Federal...

The U.S. Department of Health and Human Services recently announced that Qualified Health Plans (sold on and off the Exchanges) are not “Federal health care programs” for purposes of the federal...

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CMS Proposed Rule Reflects Increased Sophistication in Administration of...

Addressing issues ranging from participation in Part D Plan pharmacy networks to compliance training for so-called first-tier, downstream and related entities, the Proposed Rule covers numerous topics...

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CMS Proposes Significant Changes to Medicare Part D Program’s Administration

The Centers for Medicare & Medicaid Services proposes significant changes to several key Medicare Part D Program components, such as the “any willing pharmacy” contracting requirement, that will...

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CMS Indicates Select Controversial Part D Proposals Will Not Be Finalized

Acknowledging concerns regarding some proposals in the January 2014 proposed rule for the Medicare Advantage and Part D Programs, the Centers for Medicare & Medicaid Services states it does “not...

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2015 Notice of Benefit and Payment Parameters

The Centers for Medicare & Medicaid Services (CMS or the agency) kicked off a flurry of springtime regulatory activity for health insurance issuers with publication of the final Notice of Benefit...

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Medicaid Managed Care Update: CMS Proposes a National Medicaid MLR Standard

States would have the option to create binding Medicaid MLR requirements modeled after existing commercial market MLR standards. This article is part of a series that takes an in-depth look at several...

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King v. Burwell: When Would a Supreme Court Ruling Restricting Affordable...

The Supreme Court of the United States is poised to decide a critical question under the Affordable Care Act: whether the federal government can subsidize health insurance premiums for residents of...

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King v. Burwell Decision Upholds Subsidies in Federal Exchanges

On June 25, 2015, the Supreme Court of the United States ruled in King v. Burwell that the Affordable Care Act (ACA) requires premium tax credits to be made available in states that use a federal...

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CMS’s Final Medicaid Rule Creates a Medicaid MLR Framework but Leaves Room...

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)...

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Managing the Transition to Transformation: Implementing a CJR Collaborator...

Summary - McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the...

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How Congress, President-Elect Trump Might Proceed on Promise to Repeal,...

President-elect Donald Trump has vowed to repeal and replace the Affordable Care Act (ACA). This campaign promise, which echoes a familiar refrain from Republicans since ACA’s passage, is more complex...

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21st Century Cures: Congress Enacts Medicare Advantage and Small Business...

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...

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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...

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Trump Administration Takes First Steps to Support Exchanges, but Key...

In an effort to stabilize the Exchanges and encourage issuer participation, the Centers for Medicare & Medicaid Services (CMS) recently extended the federal Exchange application and rate filing...

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CMS Aims to Stabilize Exchanges but Does Not Address Issuers’ Biggest Questions

CMS recently released a final rule with the goal of stabilizing Exchange markets for 2018. The agency also issued several significant guidance documents where CMS extended the deadlines for 2018 rate...

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

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...

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CMS Opens Module for MA Plans to Report MACRA Other Payer Advanced APM...

The other payer advanced alternative payment model (APM) option is intended to give eligible clinicians an additional option to meet MACRA’s escalating participation thresholds to qualify for the 5...

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CMS to Allow Medicare Advantage Organizations to Utilize Step Therapy for...

The Centers for Medicare & Medicaid Services recently announced that, in a reversal of prior policy, it will begin to allow Medicare Advantage organizations (MAOs) to implement step therapy for...

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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...

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CMS Seeks to Provide Flexibility and Facilitate Innovation in Medicare...

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...

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Special Report - 2019 Hospital and Health Systems Year in Review

Hospitals and health systems are facing consumer demand for innovation, the need to expand and enhance streams of revenue and the push for improved quality, all while navigating changing regulations,...

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CMS Guidance and Waivers for MA and Part D Plans’ Response to COVID-19

Over the past week, the Centers for Medicare & Medicaid Services (CMS) has made a number of announcements related to Medicare coverage in connection with the Coronavirus (COVID-19) outbreak....

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[Ongoing Program] HPE New York 2020 - October 29th, 10:00 am - 1:30 pm EDT

HPE New York brings together preeminent healthcare private equity executives and investment bankers and unmatched keynote speakers to your remote workspace in a cutting-edge format – unlike any other...

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[Ongoing Program] HPE New York 2020 - Part 1 - October 7th, 12:00 pm - 1:30...

Maintain Connections with Healthcare Leaders. Stay Current on Market Trends. Look Ahead to 2021 and Beyond. Join us virtually for McDermott's signature HPE New York conference. We'll bring together...

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[Ongoing Program] HPE New York 2020 - Part 2 - October 14th, 12:00 pm - 1:30...

Maintain Connections with Healthcare Leaders. Stay Current on Market Trends. Look Ahead to 2021 and Beyond. Join us virtually for McDermott's signature HPE New York conference. We'll bring together...

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[Ongoing Program] HPE New York 2020 - Part 3 - October 21st, 12:00 pm - 1:30...

Maintain Connections with Healthcare Leaders. Stay Current on Market Trends. Look Ahead to 2021 and Beyond. Join us virtually for McDermott's signature HPE New York conference. We'll bring together...

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[Webinar] CMS Direct Contracting Model: Evaluating Participation and Managing...

The Centers for Medicare and Medicaid Services (CMS) Direct Contracting Model presents an exciting move towards value-based care with benefits for participants, providers and patients alike. However,...

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CMS Unveils Geographic Direct Contracting Model

The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a Letter of Interest (LOI) for a new geographic model option within the Direct Contracting portfolio. The geographic...

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[Webinar] Managed Care Spotlight: Recapping 2020 and Looking Ahead to 2021 -...

Over the past year, we saw significant developments in managed care regulation at the federal and state levels, and we anticipate the rapid pace of change to continue in 2021. In this webinar,...

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[Webinar] Payor-Provider Joint Ventures: Advanced Seminar - April 20th, 12:30...

As the lines between payors and providers continue to blur, the market is awash with payor-provider joint ventures, and McDermott is at the forefront of structuring and negotiating these strategic...

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CMS Announces Request for Applications for Participation In the ACO REACH Model

On February 24, 2022, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a Request for Applications (RFA) for the Accountable Care Organization (ACO) Realizing Equity,...

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[Event] 2022 Hospitals & Health Systems Innovation Summit - October 20th, New...

Join us for our third annual Hospitals & Health Systems Innovation Summit and connect with C-suite executives, in-house counsel and other industry leaders as they share insights on how to innovate,...

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McDermott Health 2023 Annual Report: Managed Care 2022 Year in Review

The managed care space saw a number of regulatory and legislative developments in 2022 that are shaping the sector as we move further into 2023. Against this backdrop, the healthcare sector itself has...

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HPE Miami 2023 | Revolutionizing Healthcare with Value-Based Care

During this session, Samarth Chandra, Kunal Kain, John Smith and Partners Jeremy Earl and Kate McDonald moderated a panel that examined the current market for value-based care companies and how...

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ERISA Preemption Developments in Managed Care

For plans governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (ERISA), the doctrine of federal ERISA preemption over state statutes, regulations or administrative...

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VBC Symposium 2023 | Find Your Niche: Value-Based Models for Clinical...

During this session, Partner Jeremy Earl moderated a panel that collected insights on how specialists can participate in value-based care and the unique challenges specialists face in maximizing...

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VBC Symposium 2023 | Innovations in Value-Based Care for Complex Populations

During this session, Partner Jeremy Earl moderated a panel that discussed how value-based care models are delivering care to individuals with complex conditions and those with significant healthcare...

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[Event] HPE NYC 2023 - October 13th, New York, NY

HPE NYC 2023 is going to be the best yet! Connect with and gain insights from top executives, innovative founders and visionary investors who are leading the charge in healthcare private equity. Expect...

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[Webinar] The Rise of the Payvider: Joint Ventures Between Health Systems and...

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...

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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...

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CMS Interoperability and Prior Authorization Rule Significantly Impacts...

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website),...

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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...

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