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

CMS Proposes Adoption of Updated Life Safety Code

Wednesday morning, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding adopting the 2012 edition of the Life Safety Code (LSC). CMS states the updated code contains new provisions that are...more

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers

As part of the Affordable Care Act, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers...more

Tax Developments Affecting Health Care Organizations and Investor-Owned Hospital Companies [Video]

Several Treasury regulations, revenue procedures, and other developments have recently been released, which may have important consequences for businesses, including health care organizations. Moreover, changes in regulatory...more

CMS Releases 2012 Physician Medicare Data: Five Takeaways

On April 9, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (the “Data File”). The Data File contains...more

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace

At a Centers for Medicare & Medicaid Services ("CMS") teleconference titled "Compliance Reviews in the Federally-Facilitated Marketplace" ("FFM"), which was held on April 10, 2014, CMS representatives discussed the agency's...more

Special New York Edition: Summary of the 2014-2015 Work Plan of the New York State Office of the Medicaid Inspector General

On April 2, 2014, the New York State Office of the Medicaid Inspector General (OMIG or the Agency) released its Medicaid Work Plan (the Work Plan) for federal fiscal year 2014. OMIG’s core function is to prevent, detect, and...more

SDNY Dismisses False Claims Act Complaint, Finding Relators Misconstrued Medicaid Program Legal Framework

A False Claims Act case against the New York City Department of Education (NYCDOE) was dismissed on March 25, the district court holding that Medicaid providers (such as school districts that provide health services) cannot...more

2015 Payment Notice and Final Call Letter: A Mixed Bag for Medicare Advantage and Prescription Drug Plans

On April 7, 2014, the Centers for Medicare & Medicaid Services ("CMS") released the Announcement of Calendar Year ("CY") 2015 Medicare Advantage ("MA") Capitation Rates and Medicare Advantage and Part D Payment Policies...more

Third Circuit Rules General Assistance Days May Be Excluded from DSH Payments

The Third Circuit recently issued an opinion in Nazareth Hospital et al. v. Sebelius, No. 13-2627, holding that Medicaid pilot projects, known as Section 1115 waiver projects, were different enough from the State of...more

President Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions

In This Issue: - One-Year Medicare Physician Fee Schedule Fix - Valuation of Services Under the Physician Fee Schedule - ICD-10 Delay; LTCH Moratorium to Become Effective Immediately - Skilled Nursing...more

HEB Grocery Company Agrees to Pay $12 Million to Settle Texas Medicaid Fraud

On March 17, 2014, a Texas state court dismissed a qui tam lawsuit against HEB Grocery Co. after HEB reach an agreement with the Texas Attorney General’s Civil Medicaid Fraud Division to pay a combined $12 million to settle...more

New Approaches – and Increasing Oversight – for Medicaid Managed Long Term Services and Support

Approximately one-third of Medicaid spending, $136 billion, is on long-term services and supports (LTSS). While the majority of Medicaid LTSS takes place in institutional settings, such as nursing facilities and mental...more

Health Reform + Related Health Policy News - April 2014

In This Issue: - Top News ..Sebelius: No More Health Law Delays; No Enrollment Extension ..CMS Announces Innovative Hospice Care Model - State News ..17 States and D.C. Implementing SHOP Health Insurance...more

Manatt on Medicaid: New Hampshire Elects to Expand Medicaid Using Private Plans

Last week, New Hampshire’s governor signed a law (Senate Bill 413-FN-A) that will expand Medicaid to adults with incomes up to 133 percent of the federal poverty line. The law is expected to result in some 50,000 New...more

Health Care Update

In This Issue: Implementation of the Affordable Care Act; Other Federal Regulatory Initiatives; Other Congressional and State Initiatives; Upcoming Hearings and Markups; Excerpt from Implementation of the...more

Whistleblowers, Do Tell?

Whizzle Blour, a professor of surgery at University Medical School, complained to his supervisor that trauma residents at University Hospital were treating and operating on patients without an attending physician’s...more

Manatt on Medicaid: The Basic Health Program: New Final Guidance Offers Insight Into Program Rules and Financing

The Patient Protection and Affordable Care Act (ACA) gives states the option to establish a Basic Health Plan (BHP)—an alternative coverage vehicle for lower-income individuals who would otherwise be eligible for Marketplace...more

After Arkansas Supreme Court Reverses $1.2 Billion Medicaid False Claims Verdict, Will State Attorneys General Rethink the Use of...

On March 20, 2014, the Arkansas Supreme Court reversed a $1.2 billion judgment against Johnson & Johnson and its related companies over alleged Medicaid fraud stemming from the off-label marketing of the drug Risperdal. This...more

Health Care Update

In This Issue: Implementation of the Affordable Care Act; Other Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Upcoming Hearings and Markups. Excerpt from...more

Ohio Medicaid Expansion Underway

Last fall, Ohio became the 25th state to file a state plan amendment to extend Medicaid benefits to approximately 275,000 Ohioans who previously were not eligible for the program. In doing so, Ohio also agreed to accept an...more

Seeing Dollar Signs: U.S. Settles with Ophthalmologist for $1.4 Million to Resolve FCA Claims

Last week, the United States settled with a Baltimore ophthalmologist for alleged violations of the False Claims Act (“FCA”). Pursuant to the settlement, the ophthalmologist, Dr. John Arthur Kiely, agreed to pay $1.4 million...more

Health Update -- Manatt on Medicaid

Manatt on Medicaid: New Strategy for Financing 12 Months of Continuous Coverage for Newly Eligible Adults - The federal government recently issued sub-regulatory guidance that will allow states to receive 98.7 percent...more

HHS DAB Upholds Revocation of Clinic’s Medicare Provider Number

On February 20, 2014, the US Department of Health and Human Services, Departmental Appeals Board upheld CMS’ revocation of the Medicare provider number of a clinic/group practice. In Advanced Care Medical Center v CMS...more

New Development Regarding Medicaid STAR+PLUS Network Provider Agreements for Texas Nursing Homes

Beginning this fall, Texas nursing home reimbursement will be converted to Medicaid Managed Care. In preparation for the Medicaid Managed Care rollout, Texas Managed Care Organizations ("MCOs") recently sent out network...more

FY 2015 Budget Request Includes Reductions and Reforms to CMS Spending

President Obama has released the administration’s FY 2015 budget request, and it includes investments and proposals for HHS that are estimated to save $355.6 billion over 10 years. The FY 2015 budget estimate for CMS is...more

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