Articles and Blogs

Medicare Advantage

Update: CMS to Annually Audit All Medicare Advantage Plans and Accelerate Completion of Prior Payment Year RADV Audits

[06/20/25]

Posted on June 20, 2025 in Health Law News

Published by: Hall Render

On May 21, 2025, the Centers for Medicare & Medicaid Services (“CMS”) announced a substantial expansion of its Risk Adjustment Data Validation (“RADV”) audit program for all Medicare Advantage (“MA”) plans. Effective immediately, CMS will audit all eligible MA plans annually and aims to complete outstanding audits for prior payment years (“PY”) 2018-2024 by... READ MORE

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CMS Rule on Agent Broker Compensation Paused by Texas Federal Court

[08/01/24]

Posted on August 1, 2024 in Health Law News

Published by: Hall Render

On July 3, 2024, a federal court in Texas (“the Court”) issued a stay related to certain provisions of CMS’s Contract Year 2025 Medicare Advantage and Part D (“MAPD”) Final Rule (“2025 Final Rule”), which would change how agents and brokers are paid by Medicare Advantage (“MA”) and Part D plans. Specifically, the Court... READ MORE

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CMS Updates Definition of Marketing for Medicare Advantage and Part D Plans: What Does this Mean for Plans?

[05/16/23]

Posted on May 16, 2023 in Health Law News

Published by: Hall Render

Could it be that CMS is implementing changes in the Medicare Communications and Marketing standards that will change the content and tone of the omnipresent television and radio advertisements targeted at potential enrollees? On the heels of publishing a final rule modifying the regulations for Medicare communications and marketing in April, on May 10,... READ MORE

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CMS Proposes Major Overhaul to Incorporate Payer Pricing into Medicare Cost Report Data and MS-DRG System

[05/19/20]

Posted on May 19, 2020 in Health Law News

Published by: Hall Render

On May 11, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released the 2021 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). One of the most significant updates is the proposed addition of a new requirement to the Medicare cost report submission process. Specifically, hospitals would be required to provide the median... READ MORE

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Temporary Suspension of Medicare Sequestration and Increased DRG Payments Under the CARES Act: But What About Medicare Advantage?

[04/08/20]

Posted on April 8, 2020 in Health Law News

Published by: Hall Render

Section 3709 of the Coronavirus Aid, Relief, and Economic Security Act of 2020 (“CARES Act”) temporarily suspends Medicare sequestration for the period of May 1 through December 31, 2020. As a result, health care providers can expect to receive an increase in fee-for-service Medicare payments by approximately 2% as compared to what they would... READ MORE

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Additional Telehealth Benefits Coming to Medicare Advantage in 2020

[07/12/19]

Posted on July 12, 2019 in Health Law News

Published by: Hall Render

Thanks to a final rule issued by the Centers for Medicare & Medicaid Services (“CMS”) this spring, Medicare Advantage (“MA”) plans will now be able to offer additional telehealth benefits to enrollees starting in 2020. Historically, MA plans have been able to offer more telehealth services compared to Original Medicare as part of their... READ MORE

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CMS Updates Preclusion List Requirements for Medicare Advantage and Part D

[05/10/19]

Posted on May 10, 2019 in Health Law News

Published by: Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) recently published a final rule (“Final Rule”) revising the procedures that CMS uses to administer its Preclusion List. As outlined below, CMS now requires Medicare Advantage, Medicare Part D and other designated plans to deny payment for items or services provided by or prescribed by a... READ MORE

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CMS Allows Medicare Advantage Plans to Implement Step Therapy for Part B Drugs – Will It Really Lower Drug Costs or Simply Increase Administrative Burdens?

[09/19/18]

Posted on September 19, 2018 in Health Law News

Published by: Hall Render

On August 7, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum (“Memorandum”) announcing a policy change to allow Medicare Advantage (“MA”) plans to implement step therapy programs for physician-administered and other Part B drugs. Step therapy is a type of prior authorization for drugs in which a health plan requires... READ MORE

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Court Vacates 60-Day Rule for Medicare Advantage Plans, Creates Uncertainty for Same Rule Applicable to Medicare-Enrolled Providers

[09/17/18]

Posted on September 17, 2018 in Health Law News

Published by: Hall Render

Nearly a decade has passed since the U.S. Congress enacted the Patient Protection and Affordable Care Act (the “ACA”). Since March 2010, we have seen federal court rulings on numerous challenges to the ACA itself and the executive branch’s efforts to enforce the ACA. One such challenge resulted on September 7, 2018 in the... READ MORE

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CMS Removes Compliance Training Requirements for Downstream Providers Under Medicare Advantage and Part D

[07/05/18]

Posted on July 5, 2018 in Health Law News

Published by: Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) recently enacted a Final Rule removing certain compliance training requirements previously applicable to first tier, downstream and related entities (“FDRs”) of Medicare Advantage and Part D Plan Sponsors (“Plan Sponsors”). Specifically, beginning in plan year 2019, health care providers that participate in Medicare Advantage and Part... READ MORE

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