On April 22, 2024, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-2439-F), effective July 9, 2024, aimed at advancing healthcare access,...more
The New York Department of Health (DOH) recently announced it is accepting applications for New York Health Equity Reform: Social Care Networks regional grants. The nine regional grants will distribute a total of $500 million...more
The House and Senate were both in session this week, with healthcare activity at the committee level. The House Energy and Commerce Committee held a hearing on innovation and a markup of 15 healthcare bills. The Senate...more
On July 13, 2022, the New York State Office of Medicaid Inspector General (OMIG) published proposed rules in the New York State Register to implement provisions of the State Fiscal Year 2020-2021 Enacted Budget and the...more
On November 20, 2020, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) finalized its previously abandoned 2019 proposal to exclude certain rebates paid by drug manufacturers from the...more
ACI’s 11th Annual Advanced Forum on Managed Care Disputes and Litigation will be offered in a virtual format this year to help you make sense of these developments, and their profound impact for managed care....more
The recently released Invitations to Negotiate (ITN) for Florida’s Statewide Medicaid Managed Care program (SMMC) parallels in large part the State’s initial procurements that were released in 2012 and 2013. Where the current...more
Emerging News on Expansion - Congress Restarts Debate on the AHCA, Which Would Significantly Cut Medicaid Funding and Coverage - House Republicans have revived the debate over the AHCA, and are discussing a potential...more
Consumers could use Marketplace subsidies to purchase off-Marketplace plans under proposed Senate bill; Oklahoma and Massachusetts will pursue Medicaid and Marketplace waivers; and a Medicaid expansion bill fails in Kansas...more
Physician groups and American Enterprise Institute authors come out against ACA repeal without a replacement; Hawaii’s 1332 waiver is the first to receive federal approval; and North Carolina’s Governor moves to expand...more
OIG recently issued a report determining that South Carolina’s Medicaid Managed Care program would not have realized any savings if the state agency implemented a minimum Medical Loss Ratio (MLR) similar to the current...more
Balancing Gene Therapy’s Promise and Price - Editor’s Note: Exciting advances in science have led to developing treatment breakthroughs, such as gene scripting therapies, that could represent the first potential cures...more
President-elect Trump taps prominent conservatives with strong anti-ACA views for his healthcare transition team; House v. Burwell proceedings on cost-sharing reductions for Marketplace plans are delayed until the new...more
CMS denies Ohio’s Medicaid 1115 waiver request citing the State’s premium proposal; HHS will use 2015 risk corridors collections for remaining 2014 payments; and Alabama closes its Medicaid budget shortfall....more
In my previous blog post, I provided a brief history of Medicaid in Iowa, including sharing details on it’s current modernization and challenges. In this post, we’ll cover what’s next for Medicaid members with the move to...more
Arkansas's “Private Option” is projected to have a net impact of $438 million on state funds 2017-2021; Iowa selects MCOs for proposed Medicaid managed care transition; and, the DC Marketplace launches a robust dual-language...more
On May 17, 2013, Governor Bentley signed into law Act 2013-261, Ala. Code §§ 22-6-150 et seq., which changes the Alabama Medicaid system from a fee-for-service to a managed care program (the "Act"). This historic legislation...more
Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the...more