http://faegrebdc.com/public-health-science en-us Copyright 2000-16 FaegreBD Consulting. All Rights Reserved. http://blogs.law.harvard.edu/tech/rss 11/27/2016 9:37:10 PM On November 14, 2016, the Centers for Medicare and Medicaid Services (CMS) published the 2017 Outpatient Prospective Payment System (OPPS) final rule in the Federal Register. The rule finalizes changes to the Electronic Health Record (EHR) Incentive... http://faegrebdc.com/meaningful-use-changes-in-2017-opps-final-rule 15 Nov 2016 00:00:00:000 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 Formal complaints were recently filed with the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) regarding alleged discrimination against HIV patients in individual market health plans. Filed by the Center for Health Law... http://faegrebdc.com/when-is-an-insurance-benefit-discriminatory-landmark-complaint-seeks-to 20 Oct 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 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 The Atlantic, Faegre Baker Daniels counsel Libby Baney shared her concerns for transgender people who purchase drugs from online pharmacies. She warned that about a half of these online pharmacies are selling counterfeit drugs. http://faegrebdc.com/libby-baney-quoted-in-the-atlantic-about-online-pharmacies-and 06 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 With major health insurers such as Aetna and UnitedHealthcare scaling back participation in the Affordable Care Act (ACA) health insurance exchanges, the future of these marketplaces has been called into question. In an article for The Hill... http://faegrebdc.com/mike-adelberg-quoted-in-the-hill-about-insurers-exiting-aca 17 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 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 On April 7, Covered California—the largest state-based health insurance exchange in the country—announced changes to its plan contracts designed to improve the quality of care. The contract changes require plans selling policies through the state... http://faegrebdc.com/mike-adelberg-covered-california-introduces-major-contract-changes 17 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 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 Studies show that half of the medicines sold online are counterfeit, and there are nearly 35,000 online drug sellers, 97 percent of which operate illegally. The Alliance for Safe Online Pharmacies – Global (ASOP Global), founded by FaegreBD... http://faegrebdc.com/internet-pharmacy-safeguards-we-salute-you 11 May 2016 00:00:00:000 On April 4, CMS published its annual Call Letter for the Medicare Advantage and Part D programs. In it, CMS shared its intention to “aggressively identify and pursue instances of non-compliance” with provider directory accuracy standards. This... http://faegrebdc.com/regulators-react-to-debate-over-narrow-networks 02 May 2016 00:00:00:000 Drug and device companies have asked the Food and Drug Administration (FDA) to incorporate patients’ experiences into its review and approval of medical products, and two provisions in the 21st Century Cures bill indicate the agency will soon be... http://faegrebdc.com/nick-manetto-21st-century-cures-act-provisions-could-bring-clarity 21 Apr 2016 00:00:00:000 Insurers are sounding a more dire tone in expressing concerns that their Affordable Care Act (ACA) plans are losing money at an unsustainable rate. According to The Hill, experts expect insurers to ask regulators to approve significant increases on... http://faegrebdc.com/if-losses-persist-aca-marketplace-exits-not-out-of-the 18 Apr 2016 00:00:00:000 Facing an influx of new and expensive enrollees through public exchanges, health insurers have resorted to narrowing provider networks to cut costs. That mechanism will become more difficult as states finalize and begin to enforce network adequacy... http://faegrebdc.com/libby-baney-emphasis-on-network-adequacy-creates-opportunity-for-telemedicine 18 Apr 2016 00:00:00:000 In its 2016 Notice of Benefit and Payment Parameters, the Centers for Medicare and Medicaid Services (CMS) included new language translation requirements designed to assure that ESL populations can access and navigate exchange plans. The policy... http://faegrebdc.com/mike-adelberg-cms-wise-to-amend-language-requirements-for-exchange 14 Apr 2016 00:00:00:000