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Latest News2021-05-19T18:39:49+00:00
1711, 2022

Part B Drug Cost Sharing Adjustments Required for Medicare Advantage Plans in 2023

November, 2022|

The Inflation Reduction Act provisions mandating adjustments to cost sharing for Part B drugs subject to inflationary rebates were silent on the question of whether Medicare Advantage (MA) plans would need to adjust coinsurance for drugs subject to inflationary rebates for the previous quarter. On November 7, 2022, however, CMS released a memorandum titled, “Inflation Reduction Act Changes to Cost Sharing for Part B Drugs for Contract Year 2023 Medicare Advantage and Section 1876 Cost Plans.”

1209, 2022

Elizabeth Lippincott will Co-Chair and speak at American Conference Institute’s (ACI) Legal, Regulatory and Compliance Summit on Medicare Advantage

September, 2022|

October 12- 13, 2022 Nashville, Tennessee Elizabeth Lippincott will co-chair and speak at ACI’s Legal, Regulatory and Compliance Summit on Medicare Advantage from October 12-13, 2022, in Nashville, Tennessee.  Elizabeth’s co-chair is Karen Lam of Kaiser Permanente.  Elizabeth will be presenting alongside Teresa A. Mason of Epstein Becker Green and Julie Nielsen of Berkeley Research Group discussing "Risk Adjustment: Forecasting the Future of Enforcement and the Implications for the Compliance and Legal Landscape." 

1608, 2022

Top of Mind Tuesday: Congress Passes Bill with Major Implications for Medicare Plans

August, 2022|

The Senate and House of Representatives voted to pass the Inflation Reduction Act (IRA), a major budget bill impacting environmental, tax, and health policy, which is expected to be signed into law shortly. The bill contains numerous changes relevant to Medicare and the ACA, but most notably for Medicare prescription drug plans, the IRA will allow Medicare to negotiate prescription drug prices for a limited number of medications.

2607, 2022

Top of Mind Tuesday: New Third-Party Marketing Requirements for Medicare Advantage

July, 2022|

CMS published new marketing and communications requirements, which went into effect June 28, 2022, impacting Medicare Advantage (MA) organizations. The new requirements are intended to address beneficiary complaints associated with third-party marketing organizations (TPMOs), as well as feedback from beneficiary advocates and stakeholders concerned about the marketing practices of TPMOs that sell multiple MA and Part D products.

2202, 2022

Medicare Advantage Snapshot – Going Strong in 2022

February, 2022|

In 2005, the year I started focusing my practice on Medicare plans, fewer than 14% of Medicare beneficiaries, or roughly 6 million people, were enrolled in Medicare managed care products.  By the end of 2021, more than 26 million people, or 42% of Medicare beneficiaries, were in Medicare Advantage, and more than 46% of Medicare spending flows through this program.  Basically, in the last 17 years, Medicare Advantage transitioned from being a niche managed care option towards becoming the standard way that Americans receive their Medicare benefits.

1201, 2022

CMS Proposes Regulatory Changes to Medicare Advantage and Part D

January, 2022|

If you, like us here at SHL, have been waiting for insights into the Biden Administration’s vision and agenda for the Medicare Advantage and Part D programs, the wait is over. On Thursday, January 6, CMS proposed Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, [CMS-4192-P].  Comments on the proposed rule are due March 7, 2022. We encourage health care companies to comment individually on their highest priority issues in addition to contributing to comment letters submitted by industry associations.

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