CMS Proposes to Prohibit Overrides in Medicare Advantage

On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for the Medicare Advantage and Part D programs. Among other proposals, CMS proposed significant changes to longstanding rules on permissible payment structures for agents and brokers. Specifically, CMS proposes to prohibit “overrides” or administrative fees paid to agents and brokers outside of the fair market value enrollment compensation limits established by CMS. This could have a significant impact on MA and Part D plan arrangements with agents and brokers.

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Mary Moll Alexandre
Mary Moll (“Mimi”) Alexandre counsels clients across the healthcare industry with a particular focus on entities in the managed care arena. Mimi routinely works with health plans, health maintenance organizations, private equity funds and vendors, helping them navigate complex regulatory schemes and facilitate business objectives. Read Mary Moll Alexandre's full bio.

Jeremy Earl
Jeremy Earl represents a broad range of healthcare organizations, with a focus on managed care legal issues. His clients include health insurers, HMOs, healthcare provider organizations, pharmacy benefit managers and administrative service providers to managed care organizations. Jeremy is a practice area leader for the Managed Care Group.Read Jeremy Earl's full bio.

Kate McDonald
Kate McDonald represents clients across the healthcare industry on complex regulatory matters and high-stakes mergers and acquisitions, affiliations and other investments. She delivers strategic advice on federal and state laws applicable to health insurers and HMOs, including the downstream implications for their provider organizations and vendors, as well as the reimbursement landscape of federal healthcare programs. Kate serves as partner-in-charge of McDermott’s healthcare practice in Washington, DC. Read Kate McDonald's full bio.

Fabiola Díaz Vera
Fabiola Díaz Vera counsels healthcare organizations on a wide range of federal and state healthcare regulatory issues. She is particularly experienced in matters impacting healthcare insurance companies, including issues related to the Centers for Medicare and Medicaid Services (CMS) requirements for Medicare and Medicaid programs, the Affordable Care Act, fraud and abuse laws and regulations, and the Health Insurance Portability and Accountability Act (HIPAA). She collaborates closely with her clients on implementing operational changes related to recent federal laws including the No Surprises Act (NSA) and the Transparency in Coverage Rule. Read Fabiola Díaz Vera's full bio.




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