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Listen to this post On April 4, 2024, the Centers for Medicare & Medicaid Services ('CMS') issued the contract year 2025 (CY2025) Medicare Advantage and Part D final rule (the [...]

Listen to this post The Centers for Medicare & Medicaid Services ('CMS') released the final rule on risk adjustment data validation ('RADV') audits of Medicare Advantage ('MA') organizations (the 'Final [...]

On February 9, 2023, the Centers for Medicare and Medicaid Services ('CMS') released two highly-anticipated guidance documents (the 'Guidance') detailing the agency's proposed implementation of the Medicare Part B ('Part [...]

On January 30, 2023, the Centers for Medicare & Medicaid Services ('CMS') released the long-delayed final rule on risk adjustment data validation ('RADV') audits of Medicare Advantage ('MA') organizations (the [...]

Social determinants of health ('SDOH') consider the non-clinical factors that can profoundly impact an individual's well-being. They are extensive and often overlap, including housing instability, food insecurity, the inability to [...]

The Medicare Advantage program continues to grow in popularity among seniors. In 2022, more than 28 million people - nearly half of all Medicare beneficiaries - are enrolled in a [...]

Just in time for the holidays, the Centers for Medicare and Medicaid Services ('CMS') issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations ('MAOs') and Part D sponsors [...]

Introduction On December 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (the 'Act'). The Act provides for nearly $1.7 trillion in funding across a range of domestic initiatives, [...]

The Centers for Medicare and Medicaid Services ('CMS') has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the 'Proposed Rule'). Specifically, with [...]

The Centers for Medicare and Medicaid Services ('CMS') issued a proposed rule, 'Advancing Interoperability and Improving Prior Authorization Processes' (the 'Proposed Rule'), that is intended to improve patient and provider [...]

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of [...]

In May, we discussed the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the 'Final Rule') issued by [...]

The Inflation Reduction Act ('IRA') was signed into law by President Biden on August 16, 2022. The expansive legislation includes key health care provisions, including drug pricing reforms, inflationary rebates, [...]

Last month, the U.S. Department of Health and Human Services Office of Inspector ('OIG') released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations ('MAOs') [...]

On March 2, 2022, the Department of Health and Human Services ('HHS') Office of the Inspector General (the 'OIG') issued a new advisory opinion ('AO 22-04') related to a program [...]

Earlier this week, the Supreme Court upheld a D.C. Circuit Court decision vacating a policy of the Centers for Medicare and Medicaid Services ('CMS') that would have 'dramatically - and [...]

The Centers for Medicare and Medicaid Services ('CMS') released the much-anticipated proposed rule to lower Part D and Medicare Advantage ('MA') drug prices and beneficiary out-of-pocket expenses on November 26, [...]

In a key case being watched by the industry, Judge Collyer of the United States District Court for the District of Columbia issued an opinion today granting UnitedHealthcare's Motion for [...]