Kinal Patel at Foley & Lardner LLP

Medicare Payment Model Trends and Economic Drivers – Awaiting Direction from Trump Administration

The Medicare program continues to face long term financial pressures associated with inflationary effects on health care costs and the growing wave of aging baby boomers. The Medicare Trust Fund, which is often viewed as a...more

2/28/2025 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , CMMI , Health Care Providers , Health Insurance , Healthcare Reform , Insurance Industry , Medicaid , Medicare , Medicare Advantage , Medicare Part A , Medicare Shared Savings Program , Value-Based Care

Risk Bearing Entity Requirements: New Jersey and New York

This blog reviews the regulatory requirements that apply to risk bearing entities (RBE) in New Jersey and New York. New Jersey and New York demonstrate distinct approaches to the registration and regulation of RBEs and...more

2/25/2025 / Compliance , Financial Services Industry , Health Care Providers , Health Insurance , Healthcare , Insurance Industry , New Jersey , New York , Regulatory Requirements , Risk Management

Risk Bearing Entity Requirements: An Introduction

Providers and provider organizations are increasingly contracting with payors to manage specific patient pools and diseases on a risk basis. They are taking new and increasing financial risk to better align with payors’...more

11/19/2024 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare Advantage Organizations (MAOs) , Payor Contracts , REACH , Risk Management

CMS Proposes New All-Payor, Total-Cost-of-Care Model (AHEAD Model), Funding Opportunity for States

On September 5, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new all-payor, total-cost-of-care model that is designed to tackle growing health care costs, boost population health functions, and reduce...more

10/3/2023 / Centers for Medicare & Medicaid Services (CMS) , Funding Opportunities , Medicaid , Medicare , Total Cost of Care Model (TCOC)

CMS’ Latest Innovation Model – The Making Care Primary (MCP) Model Includes Focus on Social Determinants of Health

On June 8, 2023, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary primary care model, the Making Care Primary (MCP) Model. Highlights include the following: The MCP Model will run for 10.5...more

6/23/2023 / ACOs , Beneficiaries , Centers for Medicare & Medicaid Services (CMS) , Compensation , FQHC , Infrastructure , Medicare , Mental Health , Social Services , Value-Based Payments

Antitrust: DOJ Scuttles ACO Guidance, Unsettles Ground under Provider Joint Contracting Models

On Friday, February 6, 2023, the Department of Justice (DOJ) announced the withdrawal of the 2011 Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings...more

3/21/2023 / ACOs , Antitrust Provisions , Centers for Medicare & Medicaid Services (CMS) , Department of Justice (DOJ) , Federal Trade Commission (FTC) , Fee-for-Service , Sherman Act

Physician Practice Transactions: NY’s Proposed Review and Monitoring Increases Visibility and Adds Deal Risk

New York Governor Kathy Hochul unveiled a proposal, set forth in the Health and Mental Hygiene Article VII Legislation associated with the proposed State Executive Budget for FY2024 (see Article 45-A) (Executive Budget), that...more

2/22/2023 / Healthcare , Investors , Mergers , New York , State Health Departments

Enhancing Oncology Model - Successor to Oncology Care Model: What’s New

The Center for Medicare and Medicaid Innovation (CMMI) is launching a long awaited new oncology model, the Enhancing Oncology Model (EOM). EOM is a successor to the Oncology Care Model (OCM), which ended June 30, 2020 after a...more

7/25/2022 / Cancer , Centers for Medicare & Medicaid Services (CMS) , CMMI , Medicaid , Medicare , Public Health Emergency , Waivers

Medicare Advantage: OIG Report Finds Improper Denials

On April 27,2022, the Office of Inspector General of the Department of Health and Human Services (OIG), Office of Evaluations and Inspections, issued a report on the performance of Medicare Advantage Organizations (MAOs) in...more

5/26/2022 / Audits , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , False Claims Act (FCA) , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , OIG , Qui Tam

Value-Based Programs: CMS Redesigns Global and Professional Direct Contracting Model and Renames it “ACO REACH"

The Centers for Medicare and Medicaid Services (CMS) recently announced a redesign of the Global and Professional Direct Contracting Model (the GPDC Model) and renamed the GPDC Model the ACO REACH Model. (“REACH” stands for...more

3/10/2022 / ACOs , Centers for Medicare & Medicaid Services (CMS) , REACH , Value-Based Care

CMS Vaccine Mandate and Home Care Providers – Investor Takeaways

The COVID-19 vaccine mandate implemented by the Centers for Medicare and Medicaid Services (CMS) has affected investor interest in non-acute care providers and suppliers, including home care providers. As our colleagues...more

3/2/2022 / Biden Administration , Biden v Missouri , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , HSBC , Medicaid , Medicare , OSHA , SCOTUS , Vaccinations

Kinal Patel

Foley & Lardner LLP

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