News & Analysis as of

Medicare Advantage Qualified Health Plans Centers for Medicare & Medicaid Services (CMS)

K&L Gates LLP

CMS Finalizes New Interoperability Rule Promoting Improvements to Prior Authorization Processes

K&L Gates LLP on

On 17 January 2024, the Centers for Medicare & Medicaid Services (CMS) released a final rule outlining new interoperability and prior authorization requirements for certain payors (Final Rule). With the adoption of the Final...more

McDermott Will & Emery

CMS Interoperability and Prior Authorization Rule Significantly Impacts Payers’ Approval and Denial Practices

McDermott Will & Emery on

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website), which aims to improve prior...more

K&L Gates LLP

CMS Proposed Rule Seeks to Provide Transparency and Efficiency in Preauthorization Process

K&L Gates LLP on

INTRODUCTION - On 13 December 2022, the Centers for Medicare and Medicaid Services (CMS) published CMS-0057-P (the Rule),1 a proposed rule that, if adopted, will place new requirements on a number of entities, including...more

King & Spalding

CMS Proposes Rule to Require Certain Health Plans to Electronically Share Data with Providers Regarding Prior Authorization...

King & Spalding on

On December 13, 2022, CMS is set to publish in the Federal Register a proposed rule (Proposed Rule) requiring certain Medicare, Medicaid, Children’s Health Insurance Program, and Qualified Health Plan fee-for-service and...more

King & Spalding

Health Plan Responsibility to Pay for Hospital Inpatient Care When Members Await Placement at Post-Acute Facilities

King & Spalding on

Hospitals that attempt to discharge a patient to a post-acute level of care but are not able to because they cannot find an appropriate accepting facility must continue providing care if the patient cannot be safely...more

Alston & Bird

A&B Healthcare Week in Review

Alston & Bird on

I. REGULATIONS, NOTICES, & GUIDANCE - On April 4, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the Final Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage (MA) and...more

Mintz - Health Care Viewpoints

CMS Takes Action Against Network Transparency While New Jersey Legislation Hits a Snag

Just as the Centers for Medicare & Medicaid Services (CMS) began holding federal health care plans accountable for their provider network transparency obligations, the New Jersey legislature stalled in its bid to pass a law...more

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