CMS Final Rule Impacting Medicare Part C, Part D and Health Information Technology Requirements


Original price was: $349.00.Current price is: $249.00.
Original price was: $349.00.Current price is: $254.00.
Original price was: $349.00.Current price is: $255.00.
Original price was: $399.00.Current price is: $251.00.

On April 4, 2024, CMS issued a Final Rule, which among other items, revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications, as well as focusing on access to types of care, anticompetitive conduct, and third-party marketing of patient data. The focus on Part C also aligns with DOJ’s priority areas of enforcement, as well as the FTC’s focus on anticompetitive violations of antitrust laws. The purpose of this webinar is to provide an overview of the key areas and tips for mitigating the risk of non-compliance.

These changes empower consumers with more choices and affordable care, while improving the quality of care for enrollees and promoting fair competition among Medicare Advantage plans. New protections against unfair marketing practices ensure enrollees are recommended plans that best suit their needs, not plans agents are financially incentivized for. Increased transparency of supplemental benefits allows enrollees to maximize their plans offerings through mid-year notifications detailing available benefits and access methods. Improved access to behavioral health care comes with new network adequacy standards, guaranteeing a wider range of providers for Medicare Advantage enrollees. More affordable prescription drugs are on the horizon thanks to the Inflation Reduction Act, capping annual out-of-pocket costs for Part D enrollees at $2,000 starting in 2025. Additionally, Part D sponsors will have more flexibility to substitute lower-cost biosimilar medications for expensive brand names. Dually eligible individuals, those receiving both Medicare and Medicaid, will benefit from a number of provisions designed to enhance their experience. These include increased access to integrated care plans and protections against out-of-network cost-sharing for specific services. Overall, these changes significantly improve the Medicare Advantage and Part D programs for beneficiaries. By increasing consumer choice, improving access to care, and promoting fair competition, CMS empowers Medicare enrollees to make informed decisions about their healthcare.

Learning Outcomes:
  • Understand the new guardrails for brokers and agents compensation models when assisting Medicare beneficiaries in enrolling in Medicare Advantage and Part D plans
  • Appreciate are impermissible contract terms between Medicare Advantage organizations/ Part D sponsors and middleman Third Party Marketing Organizations (TPMOs) that may or may not create impermissible incentives
  • Learn how the distribution, including selling and reselling of personal beneficiary data by third-party marketing organizations, implicate already existing rules and how will additional safeguards in the final rule assist with transparency
  • Understand the impact of anti-competitive practices and legal implications
  • Learn how additional behavioral health services intertwine with other laws and regulations
  • Consider how violations of the facets of this Final Rule could lead to False Claims Act liability
Areas Covered in the Session:
  • Healthcare Fraud
  • Medicare
  • Medicare Advantage
  • Medicare Part D
  • Medicare Advantage Risk Adjustment Data Validation
  • Brokers and agents compensation models when assisting Medicare beneficiaries in enrolling in Medicare Advantage and Part D
  • Medicare Advantage organizations/Part D sponsors and middleman Third Party Marketing Organizations (TPMOs) that may or may not create impermissible incentives
  • Behavioral health services updates
Recommended participants:
  • Healthcare CEOs, CFOs & COOs
  • Healthcare Sector Participants
  • Compliance and Legal Team
  • Providers
  • Consultants
  • Insurance Industry Professionals
  • Physician and Physician Assistants
  • Billers and Coders
  • Revenue Cycle Specialists
  • Government Organization
  • Defense Counsel
  • Relator’s Counsel
  • Compliance Officers
  • Healthcare Attorneys
  • Cybersecurity Professionals & Consultants
  • Anyone in Healthcare
Presenter Biography:

Rachel V. Rose, JD, MBA successfully advises and represents clients on healthcare, cybersecurity, securities, and qui tam compliance, transactional, litigation, and government enforcement matters. Ms. Rose is also an Affiliated Member with the Baylor College of Medicine’s Center for Medical Ethics and Health Policy, where she teaches bioethics. She has served as a consultative expert and testifying expert, as well as being often quoted in publications.

In addition to being extensively published and a sought-after presenter and quoted expert, Ms. Rose holds an MBA with minors in healthcare and entrepreneurship from Vanderbilt University, and a law degree from Stetson University College of Law, where she graduated with various honors, including the National Scribes Award. Ms. Rose also attained a Certificate in Negotiation and Leadership from Harvard University.

Ms. Rose is licensed in Texas and is a Fellow of the Federal Bar Association. Currently, she serves as a Director on the FBA’s National Board, is a Member of and the Immediate Past Chair of the Federal Bar Association’s Government Relations Committee, an Advisory Board member of the Federal Bar Association’s Qui Tam Section, the co-editor of the American Health Lawyers Association’s Enterprise Risk Management Handbook for Healthcare Entities (2nd Edition), as well as a co-author of the ABA’s books The ABCs of ACOs and What Are International HIPAA Considerations? She is extensively published and presents on a variety of matters related to her practice.

She has been named consecutively to the Texas Bar College, the National Women Trial Lawyers Association’s Top 25, Houstonia Magazine’s Top Lawyers (healthcare), the National Trial Lawyers Association’s Top 100 and The Nation’s Top One Percent. Ms. Rose was awarded 1st Healthcare Compliance’s 2019 and 2022 Top Presenter Award. In 2023, she was selected for SuperLawyers (healthcare).

Additional Information:

After registration, You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:
  • Internet Speed: Preferably above 1 MBPS
  • Headset: Any decent headset and microphone which can be used to talk and hear clearly
Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: +1 800-757-9502