CMS’s CY 2025 Final Rule: A Quick Summary

On November 15, 2023, CMS issued a proposed rule that proposes revisions to regulations governing Medicare Advantage (MA or Part C), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans and Programs of All-Inclusive Care for the Elderly (PACE), in Contract Year 2025 with a limited number of provisions to be applicable beginning with CY 2026. The proposed rule includes policies that would modify Star Ratings, marketing and communications guidance, agent/broker

When most of us think about artificial intelligence (AI) in healthcare, we don’t usually think about an algorithm determining if our 85-year-old grandmother [1] will be kicked out of the nursing home or if your father will be approved for the scan needed to determine the progression of cancer. We all agree that medical costs are out of control and rising faster than salaries and outpacing retirement savings and there is no doubt that a shortage of registered nurses, general p

Looking ahead to 2025 for Part D benefits, things don’t look too rosy for health plans. The Inflation Reduction Act of 2022 will be...

A bipartisan bill has recently been introduced by Senators Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) aimed at addressing risk...

2024 Submission The 2024 Medication Therapy Management Program (MTMP) submission date is June 7 and the MTMP attestations are due June 21. The 2024 annual MTM program cost threshold is $5,330 ($444.16 per month). Website Requirements The health plan website should have a separate page or section describing their MTM program using a font that is easily read and information that is easily understood. The website information should include: What the MTMP is, the purpose of the p

On March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) issued its Announcement of Calendar Year (CY) 2024 Medicare...

Part D Pharmacy Directors and Formulary administrators, Rebellis is ready to assist you with your 2023 BAT testing! Benefit...

CMS Program Audits are in full swing this summer, but are you truly prepared? If you are a Special Needs Plan (SNP) and you are not quite...

On June 7, 2022, The Centers for Medicare & Medicaid Services (CMS) announced the release of the 2021 Part C and Part D Program Audit and Enforcement Report. The report provides information on the program audit process, a current snapshot of the program audit landscape, a summary of the 2021 program audits, as well as CMS' enforcement actions. One of the most notable takeaways from the report is the largely continued trend of improved scores across each of CMS’ audit protocol

The Centers for Medicare and Medicaid Services (CMS) published the Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA)...

Now that we are through the gates of AEP/OEP season, it’s time to focus on key upcoming events: Program Audits and Timeliness Monitoring...

Co-Authored by Jennifer Young and Wendy Karsten Sign-up for our newsletter and we will send you a copy of our best practice CMS Readiness...

Co-Authored by Betsy Seals, CEO and Martha Goodlin, RN Over the past several years, we have seen an increase in CMS, OIG, and DOJ activity around recouping “improper” payments in the Medicare Program. With the new administration, the focus on identifying and recouping improper payments is almost palpable. Most recently, on August 30th, the DOJ and Sutter Health settled on Sutter paying $90 Million to Settle False Claims Act Allegations of Mischarging the Medicare Advantage Pr