Kate McDonald
Subscribe to Kate McDonald's PostsKate 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.
Provider-Sponsored Health Plans and Value-Based Care Strategies
By Brad Dennis, Kate McDonald and Matthew J. Perreault on Sep 5, 2024
Posted In Employee Benefits, Health and Welfare Plans
In response to evolving market demands, an increasing number of hospitals and health systems are considering creating provider-sponsored health plans (PHSPs), which are health insurance plans owned and operated by healthcare providers. McDermott’s healthcare team recently hosted a webinar exploring how PSHPs may offer hospitals a strategic pathway towards achieving sustainable, patient-centered care delivery by...
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CMS Proposes to Prohibit Overrides in Medicare Advantage
By Mary Moll Alexandre, Jeremy Earl, Kate McDonald and Fabiola Díaz Vera on Jan 16, 2024
Posted In Employee Benefits, Health and Welfare Plans
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...
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ERISA Preemption Developments in Managed Care
By Jeremy Earl and Kate McDonald on Apr 13, 2023
Posted In Employee Benefits, Health and Welfare Plans
For plans governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (ERISA), the doctrine of federal ERISA preemption over state statutes, regulations or administrative schemes has been a central subject of litigation since the inception of the statute. In December 2020, the US Supreme Court issued a decision on the...
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Proposed Rule on MA and Part D Would Reinstate Historical Requirements, Make Changes to Prescription Drug Payment Structure
By Kate McDonald, Mara McDermott, Ankur J. Goel, Emily Curran, Taylor Hood and Haile Dagne on Mar 3, 2022
Posted In Employee Benefits, Health and Welfare Plans
On January 6, 2022, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, marking the Biden administration’s first proposed rule on these topics. The proposed rule includes proposed changes to the manner in which...
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Leniency on Implementation Timetables for Surprise Billing and Insurer Price Transparency
By Kate McDonald on Sep 14, 2021
Posted In Employee Benefits, Health and Welfare Plans
The Biden administration is giving insurers more time to follow the insurer price transparency rule and the ban on surprise billing. Federal regulators will delay enforcement of machine-readable file provider rates until July 1, rather than the start of 2022. In this article published in Modern Healthcare, McDermott Partner Kate McDonald noted that the initial...
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Podcast | After the Curve: Focus on Health Insurance and Coverage
By Ankur J. Goel and Kate McDonald on Dec 15, 2020
Posted In Employee Benefits, Health and Welfare Plans
COVID-19 has catalyzed significant changes in the patterns of healthcare delivery, with the potential for long lasting effects on payors as a result. In this episode of the After the Curve podcast, we discuss how the COVID-19 pandemic may shift the healthcare coverage and payment landscape as well as how it may boost integration among...
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CMS Releases Broad-Ranging Medicare Advantage and Part D Proposed Rule
By Ankur J. Goel, Kate McDonald and Lauren E. Parisi on Dec 26, 2017
Posted In Employee Benefits, Health and Welfare Plans
CMS released a broad-ranging proposed rule for the Medicare Advantage and Part D Programs on Thursday, November 16, 2017. The proposed rule addresses a broad and diverse range of MA and Part D regulatory requirements, affecting not only Medicare Advantage Organizations and Part D Sponsors, but also health care providers, pharmacies, pharmaceutical manufacturers and others....
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How Congress, President-Elect Trump Might Proceed on Promise to Repeal, Replace ACA
By Ankur J. Goel, Jeremy Earl and Kate McDonald on Nov 14, 2016
Posted In Health and Welfare Plans
President-elect Donald Trump has vowed to repeal and replace the Affordable Care Act (ACA). This campaign promise, which echoes a familiar refrain from Republicans since ACA’s passage, is more complex than it may seem. There are pathways to quickly “repealing” key elements of ACA such as the individual mandate and its subsidies, but this could...
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