Health Insurance Healthcare Centers for Medicare & Medicaid Services

News & Analysis as of

Thirteen Years of the Same Rules and Now Big Proposed Changes to the Regulation of Medicaid Managed Care Plans

On May 25, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published a newly proposed rule that would change the way the agency regulates Medicaid managed care plans, the first regulation of its kind since 2002. ...more

Proposed Managed Care Rules Leave State Obligations for CHIP Largely Unchanged

The Centers for Medicare & Medicaid Services’ (CMS) proposed rule (“Rule”) that updates Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems, leaves state obligations largely...more

Washington Healthcare Update

This Week: Leading Up to the SCOTUS King v. Burwell Decision... House Votes to Repeal the Medical Device Tax... CMS Announces It Will Bolster Transitional Reinsurance Payments... MedPAC Releases June Report to Congress....more

Medicaid managed care proposed rule expands program integrity obligations

On June 1, 2015, the US Centers for Medicare & Medicaid Services (“CMS”) published its proposed rule on Medicaid managed care (CMS-2390-P). As noted in our two earlier advisories, which provided an overview of the proposed...more

Washington Healthcare Update

This Week: House Ways & Means Committee Holds Markup; Makes Significant Legislative Changes to Health Care Bills... Senate Finance Committee Holds Markup on Medicare Appeals Process Bill... CMS Issues Final Rule on...more

CMS Issues Broad-Reaching Proposals to Better Align Medicaid Managed Care with the Commercial and Medicare Markets

On May 26, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) containing the first proposed revisions to the Medicaid managed care (“MMC”) program’s regulations in more than...more

Health Care Update - May 2015 #4

In This Issue: - House Energy and Commerce Unanimously Advances 21st Century Cures Legislation - Implementation of the Affordable Care Act - Federal Regulatory Initiatives - Congressional...more

Insurer Wrongfully Passed Sequestration Cuts Through to Providers

A Pennsylvania judge found, on May 6, 2015, that a Medicare Advantage Plan had no right under its participation agreements to pass CMS sequestration reductions through to participating providers. Judge R. Stanton Wettick Jr....more

Washington Healthcare Update

This Week: Health Subcommittee Advances 21st Century Cures, Full Committee Action Scheduled…Senate Finance Committee Hearing: Chair Hatch to Launch New Initiative on Improving Chronic Care for Medicare Patients…Hawaii’s...more

IREG Update

Commercial Accountable Care Organizations - Models of health care delivery are evolving on many fronts, driven by the overriding goals of lowering the cost of health care and increasing its quality. Traditional private...more

Washington Healthcare Update

This Week: House E&C Releases Discussion Draft of 21st Century Cures Legislation Ahead of Legislative Hearing... FDA Finalizes Biosimilar Guidance Documents... CMS Updates Wage Index and Payment Rates for the Medicare Hospice...more

Manatt on Health Reform: Weekly Highlights - April 2015 #4

CMS releases new redetermination regulations and links uncompensated care funds to expanding Medicaid, and New York becomes the second state to launch the Basic Health Program. ...more

Washington Healthcare Update

This Week: Energy and Commerce Health Subcommittee Explores Post-Acute Bundling…CMS Releases First-ever Hospital Compare Star Ratings…Fiscal Year 2016 Proposed Inpatient and Long-term Care Hospital Policy and Payment Changes....more

CMS’s Proposes Rule On Mental Health Parity to Strengthen Access to Medicaid and CHIP Plans

On April 6, 2015, CMS announced a proposed rule intended to align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance. The proposed rule...more

Federal Trade Commission and Department of Justice Hold Joint Workshop on Payment Models and Competition Within the Health Care...

On February 24-25, 2015, the Federal Trade Commission (“FTC”) and Antitrust Division of the Department of Justice (“DOJ”) co-hosted a second public workshop as part of the “Examining Health Care Competition” series to study...more

Healthcare Legal News Volume 5 Number 2

According to a recent study by Accenture, by 2017 approximately 18 percent of the American public will purchase insurance through exchanges versus relying on traditional employer healthcare coverage or foregoing insurance...more

Health Care Update - March 2015

In This Issue: - King v. Burwell before the Supreme Court and the Potential Congressional Response - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional...more

Healthcare Legal News: Volume 5, Number 1

CMS ANNOUNCES NEW RULES THAT MAKE OWNER DOCTORS LIABLE FOR ALL PRACTICE MEDICARE DEBTS - Even after they leave the Practice. CMS announced its final rules on "Medicare Provider Oversight" on December 3, 2014....more

Medicare Will Cover Lung Cancer Screening

On February 5, 2015, CMS announced that it will cover lung cancer screening with low dose computed tomography (LDCT). “This is the first time that Medicare has covered lung cancer screening. ...more

Obama Administration Releases FY 2016 Budget Proposal with Medicare/Medicaid Provisions

On February 2, 2015, the Obama Administration released its proposed federal budget for fiscal year (FY) 2016. The budget would impact all types of health care providers, health plans, and drug manufacturers if adopted as...more

QNHII Regs Due Thursday—After Only Five Years

When the Affordable Care Act (ACA) was signed into law back in 2010, it directed the Centers for Medicare & Medicaid Services (CMS) to establish the Consumer Operated & Oriented Program (CO-OP). The point of the CO-OP is to...more

Manatt on Health Reform: Weekly Highlights: January 2015 #3

This week, leadership changes at CMS continue, Montana’s Governor introduces Medicaid expansion legislation, and the California Marketplace allows new health plan entrants into the individual and SHOP Marketplaces for the...more

A Quick Look at Healthcare Issues Expected to Make News in 2015

As we look into our crystal balls, we do not expect a lot of new issues in 2015. Rather, we believe that most of the significant issues will be a continuation of issues that arose in 2014 or earlier. ...more

States Doubling Down on Delivery and Payment Reform Efforts

Although health care reform implementation via the Affordable Care Act (ACA) has focused mostly on federal changes to the health care marketplace, individual States are getting some much needed help to design and implement...more

Health Headlines: Also in the News - December 2014 #3

ONC Issues New Federal Health IT Strategic Plan –On December 8, 2014, the Office of the National Coordinator for Health Information Technology (ONC) released its Federal Health IT Strategic Plan 2015-2020 (Plan). The Plan...more

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