CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021

Lexology October 29, 2018
Healthcare Law Blog

On October 26, 2018, the Centers for Medicare and Medicaid Services (“CMS”) released for viewing a proposed rule that includes significant changes for Medicare Advantage organizations (“MAOs”), Part D prescription drug plan sponsors (“PDPs”), Medicaid managed care organizations (“MCOs”), and the providers and suppliers that contract with them (the “Proposed Rule”). CMS anticipates that the Proposed Rule will be formally published in the Federal Register on November 1, 2018.

Many of the Proposed Rule’s changes would implement provisions of the Bipartisan Budget Act of 2018 (the “BBA”). Another set of proposed changes relate to program integrity initiatives including the preclusion lists that CMS established in the CY2019 MA and PDP final rule, as well as MA risk adjustment data validation...

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