Centers for Medicare & Medicaid Services Medicaid

News & Analysis as of

New Medicare Enrollment Requirements for MA Providers

In Depth - The Medicare Physician Fee Schedule proposed rule released by the Centers for Medicare & Medicaid Services (CMS) on July 7, 2016, (the Proposed Rule) requires certain providers and suppliers furnishing health...more

Integration of Technology Into Health Care Delivery

The integration of technology into health care delivery is exploding throughout the health industry landscape. Commentators speculating on the implications of the information revolution’s penetration of the health care...more

Manatt on Health Reform: Weekly Highlights - July 2016 #3

Massachusetts’s Marketplace eliminates cost-sharing for addiction treatment in subsidized QHPs; Montana cuts its uninsurance rate in half; and a Kaiser report identifies the 50 most costly drugs for Medicaid....more

CMS Guidance Addresses Impact of Value-Based Purchasing on Medicaid Drug Rebates

CMS has received questions from manufacturers regarding whether price concessions and services offered to payers within Value-Based Purchasing (VBP) arrangements in the pharmaceutical marketplace could impact their drug’s...more

Health Care Fraud Prosecutions: Strong Seas and High Winds Ahead for Individuals and Corporations

During the past nine months, the U.S. Department of Justice (DOJ) has made several significant policy pronouncements that impact health care organizations and individual providers. These directives and initiatives reflect...more

Are Changes to the Stark Law on the Way?

Congress has acknowledged that the Stark law is standing in the way of the healthcare industry's transition to alternative, value-based payment models, and in turn, meaningful reform may soon be on the horizon. Last...more

The Overpayment Rule and the Implied False Claims Theory: “What You Don’t Know Can Still Hurt You”

In 2010, the Affordable Care Act (“ACA”) enacted new rules governing overpayments made by the Medicare and Medicaid programs. Under these rules, providers have 60 days from the date that the overpayment has been identified to...more

Digital Health: An Improving Environment for Investors

The integration of technology into health care delivery is exploding throughout the health industry landscape. Commentators speculating on the implications of the information revolution’s penetration of the health care...more

New evaluation of Medicaid incentive programs shows need for improvement

Policymakers at both the federal and state levels have, in recent years, supported incentive programs designed to influence Medicaid beneficiary behavior, in the hopes that such behavioral changes will improve beneficiaries'...more

Manatt on Health Reform: Weekly Highlights - July 2016

Massachusetts extends coverage of Hepatitis C treatments and New Hampshire extends substance use disorder coverage to more Medicaid enrollees; Alaska’s Medicaid expansion now moves ahead uncontested; and CMS reports...more

Managing the Transition to Transformation: The Strategic Implications of MACRA

In Depth - On April 27, the Centers for Medicare and Medicaid Services (CMS) unveiled the much-anticipated (and, for some, feared) proposal to implement the physician payment reforms required under the Medicare Access to...more

Manatt on Medicaid: A New Focus on Managed Long-Term Services and Supports

Background - On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule to overhaul the regulations governing Medicaid managed care (MMC). MMC has evolved significantly since the...more

Summary: Oncology Care Model

Centers for Medicare & Medicaid Services - Overview - On June 29, 2016, the Center for Medicare and Medicaid Innovation (CMMI or the Innovation Center) formally launched the Oncology Care Model (OCM) at the Cancer...more

Summary: PAMA Final Rule

Market Based Payment for Clinical Diagnostic Laboratory Tests - Summary - On June 17, 2016 the Centers of Medicare & Medicaid Services (CMS) issued the long awaited Medicare Clinical Diagnostic Laboratory Tests...more

Manatt on Medicaid: Transparency and Decision Support for Medicaid Managed Care Consumers

Editor's Note: This "Manatt on Medicaid" is the eighth in a series of updates focused on CMS's new Medicaid/CHIP managed care regulations. In the coming weeks, Manatt will be exploring key provisions of the regulations and...more

Manatt on Health Reform: Weekly Highlights - June 2016 #5

Kentucky proposes premium assistance and high deductible health plans to cover expansion enrollees under an 1115 waiver; New York Legislature expresses unanimous support for a reimbursement increase for safety-net hospitals;...more

Health Update - June 2016

Real-Time Data Analytics in Government Investigations and Reducing Exposure - It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more

Understanding the Implications of MACRA, MIPS and APMs

On May 9, 2016, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking to implement the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Although the...more

CMS Proposes Changes to Payment Error Rate Measurement (PERM) & Medicaid Eligibility Quality Control (MEQC) Programs

CMS has issued a proposed rule to make changes to the PERM and MEQC programs to align with changes to state adjudication of Medicaid and Children’s Health Insurance Program (CHIP) eligibility under the Affordable Care Act....more

Manatt on Health Reform: Weekly Highlights - June 2016 #4

Massachusetts releases $1.8 billion DSRIP program waiver for public comment; CMS awards $32 million in grants to enroll uninsured children in Medicaid/CHIP; and Wisconsin withdraws proposed changes to Medicaid long-term care....more

Manatt on Medicaid: CMS Revises Process for Determining MMC Payments

In its April 25, 2016 Medicaid managed care final rule, the Centers for Medicare and Medicaid Services (CMS) provides a revised framework for determining how managed care plans should be paid by state Medicaid programs. A...more

OIG Faults State Efforts to Identify 340B Drug Claims; Cites Risk of Duplicate Discounts, Forgone Rebates

The OIG recently examined how states that pay for drugs through Medicaid managed care organizations (MCOs) identify and exclude 340B drug claims when collecting Medicaid rebates, since states are prohibited from collecting...more

OIG Mid-Year Updated Provides Insight To Its Concerns

The Office of Inspector General (OIG) recently released its mid-year update of its Fiscal Year Work Plan for 2016. The Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue. Not...more

APMs, MIPS, and the Final MSSP Rule - The Journey from Volume to Value-Based Reimbursement Continues

Since the Affordable Care Act was enacted, many providers have been shifting away from traditional fee-for-service, volume-based reimbursement models to payment mechanisms that take a data-driven approach to managing patients...more

Manatt on Medicaid: CMS Dramatically Expands Guidance on MMC Plan Payment

Editor's Note: This "Manatt on Medicaid" is the sixth in a series of updates focused on CMS's new Medicaid/CHIP managed care regulations. In the coming weeks, Manatt will continue to explore key provisions of the regulations...more

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