Medicaid

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
News & Analysis as of

MSSP Final Rule ACO Eligibility Requirements, Application and Renewal Process

This is the second post in Health Care Law Today’s series on the final rule. This post addresses Eligibility Requirements, and the Application and the Renewal Process. ACO Eligibility Requirements - Under the...more

Physicians Face Increased Anti-Kickback Enforcement Focus

It appears that the Office of Inspector General (“OIG”) now has physicians squarely in the crosshairs of one of its most powerful enforcement tools: the Anti-Kickback Statute (“AKS”). The AKS is a criminal statute with...more

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

This week...no clear consensus has emerged among congressional Republicans on how to manage potential King v. Burwell fallout; California will expand Medicaid to undocumented children; and New York is poised to become the...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

HRSA Takes its First Steps on 340B Rules

The 340B Drug Discount Program has operated for more than 20 years with just a few governing regulations codified in 42 CFR Part 10. Through the Affordable Care Act (“ACA”), Congress adopted several amendments to the 340B...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

Energy & Commerce Committee Hearing on Administration's Approval of Medicaid Demonstrations

On June 24, 2015, the House Energy and Commerce Health Subcommittee is holding a hearing to examine the Obama Administration’s approval of Medicaid demonstration projects. According to a background memo, the panel will focus...more

IRS’s Proposed Section 529A Regulations for ABLE Programs: A Mixed Bag

The IRS today published, right on deadline, its proposed regulations relating to Section 529A state-sponsored “qualified ABLE programs,” under which tax-advantaged investment accounts may be established to fund future...more

The Biggest Obstacle to Value-Based Care [Video]

In this video, Foley Partner Lawrence Vernaglia discusses the biggest obstacle to realizing a value-based system of health care, and what realistically can be done in the industry by taking "measured steps."...more

NC Legislative Update for June 2015 #3

Our thoughts and prayers go out to the families of the victims and church members of the vicious shooting in Charleston, SC. This Week - The Senate budget writers were very active this week as lawmakers worked long...more

OIG Fraud Alert Serves as Stern Warning to Physicians Regarding Compensation Arrangements

Emphasizing its continued focus on physician compensation arrangements, the OIG issued a Fraud Alert on June 9, 2015, warning that physicians risk significant penalties if medical directorships and other compensation...more

Manatt on Medicaid: New Analysis of Delivery System Reform Incentive Payment (DSRIP) Waivers—Early Results and Issues to Watch

Introduced originally in California and followed by Texas, Massachusetts, New Jersey, Kansas and New York, Delivery System Reform Incentive Payment or DSRIP programs are a key feature of the dynamic and evolving Medicaid...more

DC Circuit calls into question legality of Stark Law ban on per-click equipment leases

On June 12, 2015, the US Court of Appeals for the District of Columbia Circuit issued a lengthy decision calling into question the regulatory prohibition on per-click equipment leases under the federal physician self-referral...more

Religious Institutions: June 2015

Religious institutions commonly make payments to or receive payments directly or indirectly from governmental agencies for services rendered; e.g., day cares that benefit from public scholarships, hospitals that participate...more

Medicaid Managed Care Update: Program Integrity Proposals Include Mandatory Reporting of Overpayments by Medicaid Managed Care...

CMS seeks to impose more rigorous program integrity requirements for contractors and states. This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations,...more

The False Claims Act – the Basics Every Provider Should Know, Part One

The federal False Claims Act (“FCA”)casts an incredibly long shadow, covering every transaction between the federal government and a private party seeking payment from it. Enacted at the height of the Civil War in 1863, the...more

Medicare Shared Savings Program: Final Rule

Last week, the Centers for Medicare & Medicaid Services (CMS) released its Final Rule on the Medicare Shared Savings Program (MSSP). The Final Rule provides additional flexibility to accountable care organizations...more

Manatt on Health Reform: Weekly Highlights - June 2015 #3

With the King v. Burwell ruling expected by the end of the month, Congressional Republicans continue to offer contingency plans in the event of a ruling for the plaintiffs; and the Mississippi Insurance Commissioner proposes...more

Medicare Shared Savings Program - 2015: What's Changed, What's New, and What's to Come?

The most recent Shared Savings Program final rule, published in the Federal Register on June 9, 2015, finalizes a number of the revisions to the original November 2011 final rule that CMS proposed on December 8, 2014. In...more

Washington Healthcare Update

This Week: GOP Post-King Contingency Bills Released in Both the House and the Senate... House E&C Committee Draft LDT Bill – Creates FDA In Vitro Center, Sets Agency Review Timeline and Defines Risk Categories... CMS...more

Medicaid managed care proposed rule expands federal role in rate setting at both the managed care organization and provider level

On June 1, 2015, the US Centers for Medicare & Medicaid Services (CMS) published its proposed rule on Medicaid managed care (CMS-2390-P). According to CMS, the purpose of the proposed rule is to "modernize the Medicaid...more

Provider Alleges Retaliatory Use of Medicare Payment Suspension

A federal court has ordered discovery regarding the circumstances of a Medicare payment suspension by CMS only one week after failed settlement negotiations between a cardiology practice and the Department of Justice (DOJ) to...more

NC Legislative Update for June 2015 #2

This Week - Once again, the state’s budget has been stalled by Medicaid spending, or in this case lack thereof. The North Carolina Department of Health & Human Services (DHHS), responsible for managing the state’s...more

Administration Releases Final ACA Summary of Benefits and Coverage and Uniform Glossary Rule

On June 12, 2015, the Internal Revenue Service, Employee Benefits Security Administration, and Centers for Medicare & Medicaid Services released final regulations regarding the summary of benefits and coverage (SBC) and the...more

North Carolina General Assembly Week in Review

The Senate budget process continued this week, though at a slower pace than members had planned for in the schedule released last month. Budget votes originally scheduled for Wednesday and Thursday of this week were delayed...more

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