Although delayed as a result of the COVID-19 public health emergency, there are persistent and ongoing efforts to reform the Medicare Part D benefit. Since its June 2016 Report to Congress, the Medicare Payment Advisory...more
The Trump administration recently invited states to apply for the new Healthy Adult Opportunity Medicaid demonstration initiative, which lets states opt in to a block grant funding model for a portion of their Medicaid...more
During the Medicare Payment Advisory Commission’s (MedPAC’s) January 16 public session, MedPAC staff continued their drumbeat for reforming the Part D benefit following recommendations previously made in their June 2016...more
High out-of-pocket costs can be a significant barrier to access for Part D enrollees, especially for non-low-income subsidy (LIS) enrollees with a condition that requires an expensive specialty drug for treatment. The 2019...more
Current Medicare Part D policy requires sponsors to cover with limited exceptions “all or substantially all” drugs in six “protected” classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for treatment...more
Editor’s Note: Manatt Health modeled the extent to which hospitals and health systems could save money on post-acute care (PAC) by taking a strategic, data-driven approach to skilled nursing facility (SNF) placement....more
Hospitals and Health Systems Prepare for a Value-Based Future -
Editor’s Note: Hospitals and health systems are actively working to service their communities in numerous ways, including through the adoption of initiatives...more
2/22/2018
/ Antitrust Division ,
Cost-Sharing ,
False Claims Act (FCA) ,
Hospitals ,
Information Sharing ,
Medicare ,
Medicare Part D ,
No-Poaching ,
Opioid ,
Pharmaceutical Industry ,
Physicians ,
Substance Abuse ,
Universal Health Services Inc v United States ex rel Escobar
Vaccination utilization among U.S. adults is low, and well below the Healthy People 2020 Targets, despite widespread availability of safe and effective vaccines and long-standing use recommendations by the Centers for Disease...more
Fraud and Abuse 2017: Understanding Trends and Avoiding Actions -
Editor’s Note: In a recent webinar for Bloomberg BNA, Manatt examined game-changing fraud and abuse trends and cases—and revealed strategies for avoiding...more
11/27/2017
/ Affordable Care Act ,
Anti-Kickback Statute ,
Antitrust Division ,
Caronia ,
Centers for Medicare & Medicaid Services (CMS) ,
Digital Health ,
False Claims Act (FCA) ,
Food and Drug Administration (FDA) ,
Foreign Corrupt Practices Act (FCPA) ,
Fraud ,
Healthcare Fraud ,
Hospitals ,
Opioid ,
REMS ,
Universal Health Services Inc v United States ex rel Escobar
Using Telehealth as a Tool for Health System Integration -
As discussed in our August Health Update article on patient engagement and digital health—the first in our new digital health series—the advent of digital and...more
HIPAA and Emerging Technologies -
Editor’s Note: According to a HIMSS Mobile Technology Survey of healthcare provider employees, about 90% say they are using mobile devices to engage patients in their healthcare—and 36%...more
6/23/2017
/ Anticompetitive Agreements ,
Breach Notification Rule ,
Bring Your Own Device (BYOD) ,
Cost-Sharing ,
Department of Justice (DOJ) ,
Email ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Internet of Things ,
Marketing ,
Medicare Part D ,
Mobile Apps ,
PHI ,
Text Messages