Healthcare Reform

News & Analysis as of

Federal Judge Refuses FTC Request to Block Hershey/Pinnacle Deal; FTC to Appeal

Hospitals and other providers who have been tracking Federal Trade Commission (FTC) and Department of Justice Antitrust Division hospital merger challenges over the last several years will want to take note of the federal...more

Coordinating your reimbursement and regulatory strategies for a successful product launch

Ensuring appropriate third-party reimbursement for a new pharmaceutical or medical product involves an intricate interplay of considerations. There is no doubt that government and private payers have been under increasing...more

CMS Finalizes Major Reforms of Medicaid/CHIP Managed Care Rules

On May 6, 2016, CMS is publishing a final rule to update Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to more closely align with Medicare Advantage (MA) and private health plan standards,...more

CMS Announces Major Multi-Payer Comprehensive Primary Care Plus (CPC+) Model

CMS has launched a new “Comprehensive Primary Care Plus” (CPC+) model to improve how primary care is delivered and reimbursed. According to CMS, the CPC+ initiative (which builds on the ongoing Comprehensive Primary Care...more

State Efforts to Combat Drug Price Increases

Growth in health care costs has long been a source of political and administrative tension for public health agencies across the country. More and more, health officials, legislators, patient advocacy groups, and third-party...more

CMS Finalizes MHPAEA Mental Health/Substance Abuse Disorder Parity Rules for Medicaid Managed Care and Alternative Benefit Plans,...

CMS has released its final rule to apply provisions of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to Medicaid beneficiaries who receive services through managed care organizations or alternative...more

House Budget Committee Clears FY 2017 Budget Resolution with Medicare, Medicaid Cuts

The House Budget Committee has approved the budget resolution providing instructions to Congressional committees on the federal spending framework for FY 2017. The resolution calls for the adoption of major reforms to the...more

CMS Ahead of Schedule in Push for Medicare Alternative Payment Models

CMS has announced that has reached its goal of tying 30% of Medicare payments to alternative payment models that reward quality of care rather than volume of service — 11 months ahead of the target CMS set last year....more

House Unanimously Approves Legislation to Remove Terminated Providers from Medicaid, CHIP

The House of Representatives has unanimously approved H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act. The bill, which still awaits Senate consideration, would implement several OIG recommendations to improve...more

Energy & Commerce Committee Advances Medicaid/CHIP Legislation with Lower Provider Tax Limit

The House Energy & Commerce Committee has voted to approve H.R. 4725, Common Sense Savings Act of 2016, which includes a number of Medicaid and Children’s Health Insurance Program (CHIP) reforms. Among other things, the bill...more

COPN Reform Efforts Delayed

Few legislative issues during the 2016 General Assembly have garnered more attention in the health care community than the efforts to reform Virginia’s Certificate of Public Need (“COPN”) process. Despite considerable effort...more

Manatt on Health Reform: Weekly Highlights - March 2016 #2

The IRS releases guidance on resolving Form 1095 conflicts; New Hampshire's Medicaid expansion renewal clears a hurdle in the State; and New York providers get $1.5 billion in long-awaited DSRIP capital and infrastructure...more

GAO Reviews Safeguards on State Supplemental Medicaid Payments to Hospitals

According to the GAO, 505 hospitals received Medicaid payment surpluses (payments that exceeded the costs of providing services) totaling about $2.7 billion in 2012, resulting in part from lump-sum supplemental payments...more

Update No. 2: Is This The Year Florida Recognizes Direct Primary Care?

House Bill 37 (“HB 37”), a bill intended to codify and regulate direct primary care in the State of Florida, which had sailed through the Florida House with virtually unanimous support, died in the Senate as the legislative...more

Donald Trump Proposes Prescription Drug Importation as Element of Health Reform Plan

Donald Trump has released his plan for “Healthcare Reform to Make America Great Again”, which includes a proposal for allowing importation of cheaper prescription drugs from other countries as one of the reforms he believes...more

Donald Trump Offers his Proposal for “Healthcare Reform to Make America Great Again”

What would federal health policy look like under a Trump Administration? Donald Trump outlined his plan for “Healthcare Reform to Make America Great Again” on March 2, 2016. The heart of the plan is a call for Congress to...more

Manatt on Health Reform: Weekly Highlights - March 2016

STATE STAFFING UPDATES: Nevada: New Insurance Commissioner Appointed - The Director of Nevada's Department and Industry announced Barbara Richardson as the Commissioner of the Division of Insurance. Richardson...more

CMS Proposes Program Integrity Enhancements to the Provider/Supplier Enrollment Process, including New Affiliated Provider...

On March 1, 2016, CMS published a proposed rule that would make a variety of changes to the Medicare, Medicaid, and CHIP provider and supplier enrollment requirements. CMS believes that the proposal would assist in ensuring...more

Congressional Health Policy Hearings - February 2016

Several Congressional committees have held hearings recently on health policy issues, including: ..A House Energy and Commerce Health Subcommittee hearing on the Medicaid and CHIP Federal Medical Assistance Percentage...more

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

Medicaid expansion cuts the number of low-income adults without health insurance in Kentucky by nearly 70%; the Georgia legislature considers a "Private Option" coverage expansion bill; and CMS and AHIP collaborate on quality...more

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

Alabama receives federal approval for its Medicaid transformation waiver, while Michigan's Governor submits a Medicaid waiver on behalf of Flint residents; CMS announces $7.7 billion in reinsurance payments; and Vermont seeks...more

Issue 99: Transition Relief for Student Health Plans and Other ACA Issues Impacting Student Employees

This is the ninety-ninth issue in our health care reform series of alerts for employers on selected topics in health care reform. This series of Health Care Reform Management Alerts is designed to provide a more in-depth...more

Manatt on Health Reform: Weekly Highlights - February 2016 #2

CMS details requirements for Kentucky's transition to HealthCare.gov; a new special enrollment period is established for subsidy-eligible individuals who failed to file their 2014 taxes; and President Obama sends his final...more

Manatt on Health Reform: Weekly Highlights - February 2016

Virginia submits a $1 billion DSRIP application; Michigan's Governor will request authority to extend Medicaid coverage to Flint residents aged 21 and under; and Hawaii reinstates small business tax credits in its updated...more

Washington Insight - January 2016

President Obama Delivers State of the Union Address - In his eighth and final State of the Union address, President Obama focused on his views of and hopes for the future beyond his last year in office. Rather than...more

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