http://faegrebdc.com/health-economics en-us Copyright 2000-16 FaegreBD Consulting. All Rights Reserved. http://blogs.law.harvard.edu/tech/rss 11/28/2016 3:06:16 AM The election of Republican Donald Trump as President and a Republican-controlled House and Senate means that repeal of the Affordable Care Act (ACA) — long a top but unattainable Republican priority — is now a looming reality. It goes without saying... http://faegrebdc.com/obamacare-after-obama-a-nascent-trump-administration-considers-options 10 Nov 2016 00:00:00:000 While much attention is being paid to what the health care agenda for the next presidential administration will look like and who the key players will be, stakeholders need to be preparing for near-term opportunities and challenges looming ahead in... http://faegrebdc.com/understanding-the-health-care-agenda-during-the-lame-duck-session 04 Nov 2016 00:00:00:000 On October 31, 2016, the Centers for Medicare and Medicaid (CMS) awarded $25.5 million to 22 states to enhance their enforcement and oversight of health insurers with select Affordable Care Act (ACA) regulations and reforms. These awards speak to... http://faegrebdc.com/trick-or-treat-new-grants-position-states-to-be-more 02 Nov 2016 00:00:00:000 In an article for Medicare Advantage News, FaegreBD Consulting Senior Director Mike Adelberg explained how the Centers for Medicare and Medicaid Services (CMS) seem to be making two points with stricter regulations for both Medicare Advantage and... http://faegrebdc.com/mike-adelberg-discusses-cms-fines-with-medicare-advantage-news 04 Oct 2016 00:00:00:000 In an article for Inside CMS, FaegreBD Consulting Senior Director Mike Adelberg commented on the news that health care insurers will not receive any money under the risk corridor program for 2015 because the collected money is going towards benefit... http://faegrebdc.com/mike-adelberg-discusses-2015-risk-corridor-funding-with-inside-cms 22 Sep 2016 00:00:00:000 In an article for Medicare Advantage News, FaegreBD Consulting Senior Director Mike Adelberg shared his thoughts on a recent decision by CMS (Centers for Medicare and Medicaid Services) to lower its highest star rating to 2.5 stars for contracts... http://faegrebdc.com/mike-adelberg-discusses-cms-star-ratings-with-medicare-advantage-news 19 Sep 2016 00:00:00:000 David Brooks, an op-ed columnist for the The New York Times, used a quote from FaegreBD Consulting Senior Director Mike Adelberg from a Vox article where he discussed the shrinking Affordable Care Act (ACA) marketplace and its resemblance to similar... http://faegrebdc.com/the-new-york-times-picks-up-quotes-from-mike-adelberg 07 Sep 2016 00:00:00:000 In an article for Inside CMS, FaegreBD Consulting Senior Director Mike Adelberg shared his thoughts on why the Centers for Medicare and Medicaid Services (CMS) decided to reduce its new provider network rating initiative for the federally-run... http://faegrebdc.com/mike-adelberg-quoted-in-inside-cms-about-new-network-rating 01 Sep 2016 00:00:00:000 With multiple large insurers leaving the Affordable Care Act (ACA) marketplace, some are questioning the possibility of a market failure. In many places in 2017, the ACA marketplace will offer fewer consumers extensive options or rich benefits. In... http://faegrebdc.com/mike-adelberg-quoted-in-vox-on-affordable-care-act-successes 29 Aug 2016 00:00:00:000 The federal government recently blocked insurance giant, Aetna, from acquiring Humana which may have contributed to Aetna's decision to drop 70 percent of its health plans in the Affordable Care Act (ACA) markets. Amid continued losses, Aetna and... http://faegrebdc.com/mike-adelberg-quoted-in-modern-healthcare-about-aca-risk-adjustment 23 Aug 2016 00:00:00:000 FaegreBD Consulting Senior Director Mike Adelberg contributed several quotes to a recent edition of Medicare Advantage News where he discussed two different topics surrounding changes in the Medicare marketplace. In one article, Adelberg shared... http://faegrebdc.com/mike-adelberg-quoted-in-medicare-advantage-news-about-cms-secret 22 Aug 2016 00:00:00:000 In a recent Health Affairs Blog essay with professor Nicholas Bagley of the University of Michigan law school, FaegreBD Consulting Senior Director Mike Adelberg broke down the premium stabilization programs of the Affordable Care Act (ACA) that... http://faegrebdc.com/la-times-and-politico-pick-up-mike-adelbergs-affordable-care 10 Aug 2016 00:00:00:000 CMS has implemented a new policy where Medicare Advantage plans’ entire provider networks undergo review when requesting service area expansions. As Mike Adelberg, senior director for FaegreBD Consulting, explained in Medicare Advantage News, this... http://faegrebdc.com/mike-adelberg-discusses-cmss-new-network-review-policy-in-medicare 09 Aug 2016 00:00:00:000 Experts are predicting a drop in health insurer participation in Affordable Care Act (ACA) markets in the coming year, according to an article in Vox.com. Mike Adelberg, senior director for FaegreBD Consulting, told Vox that insurer participation... http://faegrebdc.com/long-term-prospects-promising-for-aca-exchanges-despite-competition-dip 04 Aug 2016 00:00:00:000 Based on QHP Certification instructions issued on July 22, 2016, the Centers for Medicare and Medicaid Services (CMS) will collect administrative and performance data from health insurers that participate in the federally-run health insurance... http://faegrebdc.com/transparencys-opaque-beginning-cms-starts-implementing-aca-transparency-requirements 27 Jul 2016 00:00:00:000 ​Medicare Advantage (MA) organizations may want to plan for a future in which they are required by the Centers for Medicare and Medicaid Services’ to hire independent auditors to confirm that they have remediated agency concerns. As Mike Adelberg... http://faegrebdc.com/mike-adelberg-discusses-medicare-advantage-audits-network-adequacy-in-medicare 15 Jul 2016 00:00:00:000 ​The Centers for Medicare and Medicaid Services (CMS) is not slowing its efforts to capture data on provider network adequacy. The agency recently unveiled a policy that will require Medicare Advantage (MA) plans to report on mid-year provider... http://faegrebdc.com/cms-continues-data-driven-approach-to-optimizing-network-oversight 08 Jun 2016 00:00:00:000 On June 3, 2016, Vermont Gov. Peter Shumlin (D) signed a bill into law that aims to increase the transparency and rationale for prescription drug prices. The law gives a new state board responsibility to identify up to 15 prescription drugs on which... http://faegrebdc.com/vermonts-verity-first-in-nation-drug-price-transparency-law 07 Jun 2016 00:00:00:000 Samantha N. Strong has joined FaegreBD Consulting as an advisor with the health and biosciences team in Washington, D.C. Strong brings a strong focus on government advocacy. Grounded in pragmatic choices and political implications, she combines... http://faegrebdc.com/samantha-strong-brings-bioethics-background-to-faegrebd-consulting 31 May 2016 00:00:00:000 In a May 9 report, the Government Accountability Office (GAO) criticized the Centers for Medicare and Medicaid Services (CMS) for failing to recover overcharges stemming from faulty payment coding in the Medicare Advantage (MA) Risk Adjustment... http://faegrebdc.com/expect-changes-to-risk-adjustment-oversight-as-cms-feels-heat 31 May 2016 00:00:00:000 In its 2017 Call Letter, the Centers for Medicare and Medicaid Services (CMS) introduced a provision that experts say has gone mostly overlooked, but should be taken seriously. The letter introduced the possibility of levying enforcement... http://faegrebdc.com/mike-adelberg-cms-ties-enforcement-actions-to-financial-audit-strengthens 17 May 2016 00:00:00:000 So far in 2016, both the Centers for Medicare and Medicaid Services (CMS) and state regulators have shown they are serious about implementing and enforcing accountability measures for network adequacy. In early April, CMS revealed that it had... http://faegrebdc.com/mike-adelberg-network-adequacy-accountability-front-and-center-in-2016 16 May 2016 00:00:00:000 Data released by the Centers for Medicare and Medicaid Services (CMS) revealed health care service disparities between minority and white populations covered under Medicare Advantage plans. Released on April 19, the data is the first of its kind... http://faegrebdc.com/cms-report-shows-deficit-in-medicare-advantage-services-for-minority 16 May 2016 00:00:00:000 In early May 2016, the Government Accountability Office (GAO) released a critical report on the inability of the Centers for Medicare and Medicaid Services (CMS) to recover overcharges from errant and aggressive payment coding in the Medicare... http://faegrebdc.com/gao-roasts-cms-for-weak-risk-adjustment-oversight-medicare-advantage 16 May 2016 00:00:00:000 Kelly M. Nickel has joined FaegreBD Consulting as an advisor with the health and biosciences team in Washington, D.C. Nickel brings a range of experience in health care and advocacy circles. Her diverse background in today’s complex government... http://faegrebdc.com/kelly-nickel-brings-diverse-background-to-health-and-biosciences-team 20 Mar 2016 00:00:00:000 In the fall of 2016, the Centers for Medicare and Medicaid Services (CMS) will begin rating health insurance exchange health plans based on the doctors and hospitals included in their networks. Mike Adelberg, senior director for FaegreBD Consulting... http://faegrebdc.com/mike-adelberg-what-to-expect-from-cms-health-insurance-rating 16 Mar 2016 00:00:00:000 The orphan drug market has grown at a “feverish pace” since 2013, according to Medical Marketing & Media, prompting disputes about the incentives pharma companies receive for developing rare-disease drugs. In the article, Nick Manetto, principal for... http://faegrebdc.com/nick-manetto-discusses-incentives-for-rare-disease-drug-development-in 29 Feb 2016 00:00:00:000 A number of health insurers are suspending or lowering commissions for brokers who sell health policies through the federal exchange during special-enrollment periods (SEPs). According to Inside Health Insurance Exchanges, insurers complain that... http://faegrebdc.com/mike-adelberg-health-insurers-docking-broker-commissions-during-special-enrollment 23 Feb 2016 00:00:00:000 Last summer, Viva Health, a small, Alabama-based nonprofit health maintenance organization (HMO), received an unexpected bill for $1.7 million from the federal government. The bill stemmed from the Affordable Care Act’s (ACA) risk adjustment... http://faegrebdc.com/mike-adelberg-aca-risk-adjustment-produces-some-surprising-results 01 Feb 2016 00:00:00:000 The Managed Care Compliance Conference will bring together leaders and professionals in managing health plan compliance for four days of educational panels and networking events. Across a wide array of presentations, the conference will cover a host... http://faegrebdc.com/managed-care-compliance-conference 31 Jan 2016 00:00:00:000