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Center for Medicare and Medicaid Services Issues a Final Rule on Medicare + Choice ("M+C")

Client Alert | 1 min read | 11.28.03

On November 28, 2003 the Center for Medicare and Medicaid Services issued a final rule enabling Medicare + Choice ("M+C") plans to offer reductions in the standard Medicare Part B premium, with the intent of making M+C plans more attractive to beneficiaries. The rule makes conforming changes to the current M+C regulations to implement section 606 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 ("BIPA"). M+C organizations can elect to receive a reduction in their monthly capitation payments under 42 CFR § 422.250(a)(1), 80% of which would be applied to either reduce or eliminate the standard Medicare Part B premiums otherwise paid by, or on behalf of, Medicare enrollees. The new regulations, added as 42 CFR § 408.21, limit the premium reduction to an amount that cannot be greater than the standard premium amount determined for the year under § 1839 of BIPA. The premium reduction must be a multiple of 10 cents, and the reduction will be applied to all beneficiaries enrolled in the M+C plan, regardless of who pays or collects the premium. Finally, the reduction can never be less than zero and will not result in a payment to a beneficiary in any given month. To be eligible for the Part B premium reduction, beneficiaries must be enrolled in an M+C plan that offers the reduction as an additional benefit. After determining applicable premium reductions, CMS will notify beneficiaries of their new benefit check amounts.

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Client Alert | 6 min read | 03.26.24

California Office of Health Care Affordability Notice Requirement for Material Change Transactions Closing on or After April 1, 2024

Starting next week, on April 1st, health care entities in California closing “material change transactions” will be required to notify California’s new Office of Health Care Affordability (“OHCA”) and potentially undergo an extensive review process prior to closing. The new review process will impact a broad range of providers, payers, delivery systems, and pharmacy benefit managers with either a current California footprint or a plan to expand into the California market. While health care service plans in California are already subject to an extensive transaction approval process by the Department of Managed Health Care, other health care entities in California have not been required to file notices of transactions historically, and so the notice requirement will have a significant impact on how health care entities need to structure and close deals in California, and the timing on which closing is permitted to occur....