Editor’s Note: Seeking methods to better understand and control healthcare costs, many states are taking a careful look at a state-defined spending target, or “benchmarking” model, that originated in Massachusetts and has...more
State interest in healthcare cost containment has grown dramatically since Massachusetts enacted the nation’s first cost benchmarking program in 2012. At that time, most states were focused on coverage expansion through the...more
Serving over 1.8 million Massachusetts residents, MassHealth provides access to healthcare services for people of varying ages and life circumstances across the Commonwealth. These services improve enrollees’ health and...more
The Massachusetts Medicaid program, MassHealth, plays a critical role as a source of health insurance coverage in Massachusetts. It covers a broad range of residents of the commonwealth, including vulnerable populations such...more
Editor’s Note: It’s welcome news that Department of Health & Human Services (HHS) Secretary Alex Azar has embraced the cause of transparency in healthcare. In a new Health Affairs blog post, summarized below, Manatt Health...more
All-Payer Claims Databases (APCDs) are some of our nation’s most powerful healthcare data assets, yet information about what they are, the populations and the types of data they include, and how they can be effectively...more
On May 4, 2018, Center for Medicaid and CHIP Services (CMCS) Acting Director Timothy Hill released an Informational Bulletin calling for states to review their Medicaid and CHIP payment policies to ensure alignment with...more
Bozeman, Mont. – According to two independent analyses released today, Montana’s 2015 bipartisan Medicaid legislation has saved more than $36 million in the state’s budget and helped more than 65,000 adults access preventive...more
For the past decade, Medicare Advantage (MA) plans added nearly 10 million members. In 2017, one-third of Medicare beneficiaries nationally had enrolled in MA plans. Western states embraced MA early, with nearly one-third of...more
Connecting Justice-Involved Populations to Health Coverage and Care -
Editor’s Note: The importance of connecting justice-involved populations to health coverage and care is evident from the high levels of physical and...more
Mental Health and Minors: Proceed With Caution! -
Imagine representing a party in a lawsuit concerning coverage for mental health services. The lawsuit was brought by the parents of a minor child. The client received a...more
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet only 1 in 5 people suffering from an OUD receive treatment. The...more
The Promise of Data-Driven Healthcare: Megatrends for 2018 -
Editor’s Note: For state health programs, payers, providers and life sciences companies, data and analytics have become essential to facilitating efficient and...more
Massachusetts Waiver Amendment Requests Partial Expansion and Closed Formulary -
On September 8, 2017, Massachusetts submitted a waiver amendment request to the Centers for Medicare & Medicaid Services (CMS) to modify its...more
Contracting With Technology Vendors: Obligations and Compliance Strategies -
Editor’s Note: In a recent webinar, Manatt Health examined how to protect privacy when communicating in the digital age. The session revealed how...more
7/25/2017
/ Antitrust Division ,
Business Associates ,
Centers for Medicare & Medicaid Services (CMS) ,
Digital Health ,
Employee Retirement Income Security Act (ERISA) ,
Fair Credit Reporting Act (FCRA) ,
Federal Trade Commission (FTC) ,
Health Insurance ,
Medicare ,
Mergers ,
Physician Fee Schedule ,
Spokeo v Robins ,
Vendors
Mapping the Healthcare M&A Landscape Under the New Administration -
Editor’s Note: The healthcare M&A market continues to be among the most active sectors. In a recent webinar, Manatt examined how the policies and goals of...more
5/25/2017
/ Acquisitions ,
Affordable Care Act ,
American Health Care Act (AHCA) ,
Antitrust Provisions ,
Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Food and Drug Administration (FDA) ,
Health Insurance ,
Healthcare Reform ,
Hospitals ,
Mergers ,
Trump Administration
CMS Issues Self-Referral Disclosure Protocol for Stark Law Violations -
On March 28, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a new voluntary self-referral disclosure protocol (SRDP) for disclosing...more
4/25/2017
/ Affordable Care Act ,
Anti-Steering Rules ,
Antitrust Provisions ,
Centers for Medicare & Medicaid Services (CMS) ,
Deceptive Intent ,
Department of Justice (DOJ) ,
Drug Pricing ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Pharmacist ,
Self-Referral ,
Stark Law ,
Telehealth ,
Trump Administration
The House currently is considering the American Health Care Act (AHCA), a bill to repeal and replace the Affordable Care Act (ACA). Among other things, the bill will phase out enhanced federal funding for the expansion of...more
The Future of Essential Health Benefits -
Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more
3/24/2017
/ Affordable Care Act ,
Antitrust Immunity ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Essential Health Benefits ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Reform ,
Insurer Liability ,
Medicaid ,
Premiums ,
Repeal ,
Trump Administration
Securing the Safety Net for America's Vulnerable Populations -
Editor's Note: America's population is aging rapidly. By 2029, 75 million baby boomers will have reached age 65 and older, and older adults will represent...more
2/22/2017
/ Aetna ,
Affordable Care Act ,
Anthem Insurance ,
Antitrust Provisions ,
Caregivers ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
CIGNA ,
Department of Justice (DOJ) ,
FMAP ,
HCQIA ,
Health Insurance ,
Humana ,
Lead Poisoning ,
Medicaid ,
Medicare Advantage ,
Mergers ,
Opioid ,
Private Sector ,
Substance Abuse ,
Whistleblower Protection Policies ,
Whistleblowers