Summer Swallow on Medicaid

Medicaid and CHIP Managed Care Final Rule: It’s All About Consistency

The Centers for Medicare & Medicaid Services (CMS) recently issued a 1,425-page regulation (Rule) on managed care in Medicaid and the Children’s Health Insurance Program (CHIP), dubbed the first overhaul of these regulations...more

5/10/2016 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Managed Care Contracts , Medicaid , Medical Loss Ratio

Medicaid Managed Care Proposed Rules: The Intersection of Private Insurance and Government Programs

Approximately a quarter of all Medicaid expenditures is spent on the more than half of all beneficiaries (approximately 39 million by 2011 figures cited in the 2014 MACPAC Report) currently accessing part or all of their...more

6/9/2015 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Health Insurance , MACPAC , Managed Care Contracts , MCOs , Medicaid , Proposed Regulation , Qualified Health Plans , Rulemaking Process

Children’s Hospitals Obtain Temporary Injunction Against CMS

Challenging actions by the Centers for Medicare & Medicaid Services (CMS) under the Administrative Procedures Act (APA), Texas Children’s Hospital and Seattle Children’s Hospital obtained a preliminary injunction that enjoins...more

1/16/2015 / Administrative Procedure Act , Auditors , Centers for Medicare & Medicaid Services (CMS) , Children's Hospital , DSH , Hospitals , Medicaid , Preliminary Injunctions , Reimbursements

Medicaid ACOs: States’ Answer to Escalating Costs?

States increasingly are experimenting with the use of Accountable Care Organizations (ACOs) in their Medicaid programs as a possible avenue to curb the escalating costs of providing care to expanding Medicaid populations....more

10/3/2014 / ACOs , Health Care Providers , Healthcare , Medicaid , Medicare

Marketing to Medicaid Beneficiaries: Texas Proposed Rule Highlights Pitfalls for Providers

Earlier this month, the Texas Health and Human Services Commission (Commission) released a proposed rule, 1 TAC § 354.1452 that prohibits certain marketing activity by Medicaid and CHIP providers. The proposed rule has been...more

2/25/2014 / Beneficiaries , Children's Health Insurance Program (CHIP) , Department of Health and Human Services (HHS) , Employee Benefits , Healthcare , Medicaid

CMS Issues Final Rule Outlining Medicaid DSH Payment Reductions

CMS recently released the final rule confirming its methodology for carrying out reductions to Medicaid disproportionate share hospital (DSH) payments for fiscal year (FY) 2014 and FY 2015. DSH payments, which go to hospitals...more

9/27/2013 / Centers for Medicare & Medicaid Services (CMS) , DSH , Final Rules , Healthcare , Medicaid

Exclusions: OIG Offers Relationship Counseling to Providers

On May 8, 2013, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued an updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs...more

5/22/2013 / Civil Monetary Penalty , Department of Health and Human Services (HHS) , Healthcare , Medicaid , Medicare , OIG , Provider Payments

Summer Swallow

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