Top of Mind Tuesday: Medicare Advantage Snapshot
In 2004, when I started focusing on Medicare plans in preparation for the 2006 implementation of Medicare Part D prescription drug benefits, only a small percentage of Medicare beneficiaries—just 13 percent or roughly 5.3 million people—were enrolled in what were then called Medicare+Choice plans.[1] Fast-forward 16 years, now 39 percent of all Medicare beneficiaries, or 24.1 million people out of roughly 62 million Medicare beneficiaries overall, are enrolled in Medicare Advantage (MA) plans.[2] The Congressional Budget Office projects the share of beneficiaries enrolled in MA plans will rise to over 50 percent by 2030.[3]
Top of Mind Tuesday: What Does the Regulatory Freeze Mean for Medicare Advantage?
We witnessed a peaceful transfer of presidential power in the United States last week. Following an inauguration in which President Biden pledged to take on a “raging virus” and “make health care secure for all,” the new administration dug in and got to work. Indeed, on the first day in office, President Biden issued seventeen executive orders, memoranda, and proclamations covering issues ranging from the environment to immigration to the economy.
Top of Mind Tuesday: When Your Government Customer Gets a New CEO
Medicare Advantage (MA) organizations have a unique relationship with the federal government. Like all healthcare companies, they interact with the government as a regulator, the industry’s rule-maker and watchdog. This is a familiar aspect of the industry-government relationship, consistent with insurers’ experience with state and federal agencies in commercial lines of business. The most successful MA plans, however, adopt a broader picture of their relationship with the government. The Centers for Medicare & Medicaid Services (CMS) is also their customer, a valuable and demanding public group health plan, responsible for safeguarding the benefits of tens of millions of Medicare beneficiaries administered by private insurers.
Sandra Durkin Presents Litigation Trends in the Era of Health Care Reform
Sandra Durkin presented at AHLA's Health Plan Law and Compliance Institute on November 15, 2019. The presentation was titled Litigation Trends in the Era of Health Care Reform: Lessons and Opportunities for Health Plans in Understanding, Avoiding, and Resolving Disputes.
Sandra Durkin will be Presenting at AHLA’s Law and Compliance Institute
Strategic Health Law’s own Sandra Durkin has been invited to speak at the American Health Lawyers Association’s Health Plan Law and Compliance Institute on November 15, 2019. Sandra will present alongside Archana Rajendra of the Henry Ford System, Health Alliance Plan Health Alliance Plan of Michigan discussing Litigation Trends in the Era of Health Care Reform: Lessons and Opportunities for Health Plans in Understanding, Avoiding, and Resolving Disputes.
2020 Medicare Communications and Marketing Guidelines Updates
Compliance with the 2020 Medicare Communications and Marketing Guidelines
I Would Do It All Again
I recently had a conversation with an attorney who has a young child. She thanked me for sharing that, when I reflect back as the mom of two boys ages 16 and 11, I am unequivocally glad I kept practicing law after having them. I decided to communicate this feeling more broadly after hesitating at first because it can be an emotional and personal topic and I didn’t want to come across as casting judgment on anyone else.
Proposed Part D e-Prescribing Transaction Standard
CMS just issued a new proposed Part D rule, which would create a new transaction standard for Part D e-prescribing and prior authorization request and response transmissions (or “ePA transaction standard”).
Our Plan Focus
Strategic Health Law’s updated website reflects our Plan Focus. Plan Focus is a mindset and a strategic commitment. We know the health plan industry like it is our own. We serve dozens of health plans, including national, regional, and local carriers. Our clients range in geographic scope from Hawaii, across the continental U.S. from the Pacific Northwest to New England and Florida and including Puerto Rico.
