Medicaid Centers for Medicare & Medicaid Services

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

President Signs MACRA: Permanently Reforms Medicare Physician Reimbursement Framework, Includes Other Medicare Payment, Program...

On April 16, 2015” (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals...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

CMS Provides Guidance to States on Managed Care Contract Review

As states attempt to control increasing healthcare costs, many Medicaid programs are seeking approval from the Centers for Medicare & Medicaid Services (CMS) to implement Medicaid managed care programs. In 2013, nearly 68...more

CMS Issues Guidance on Reimbursement for Biosimilars under Medicare and Medicaid

Biosimilars Are Generally Treated as Single Source Drugs - On March 30, 2015, in the wake of the first biosimilar product licensed by the Food and Drug Administration (FDA), the Centers for Medicare & Medicaid Services...more

CMS Issues Proposed Rule That Would Extend Provisions of Mental Health Parity

On April 6, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule that would extend provisions of the Mental Health Parity and Addiction Equity Act of 2008 (the “Mental Health Parity Act”) to...more

CMS Issues Proposed Modifications to Meaningful Use Rule

On Friday, April 10, 2015, CMS issued a proposed rule containing several important modifications to the Medicare and Medicaid EHR Incentive Programs. Among the most notable proposals is to move eligible hospitals from a...more

Washington Healthcare Update

This Week: Montana Legislature Reverses Course, Endorses Medicaid Expansion... Final 2016 Medicare Advantage and Part D Rate Announcement and Call Letter... Upcoming: Energy and Commerce Subcommittee Hearing on Post-Acute...more

CMS Takes Initial Steps to Address Medicare & Medicaid Coverage for Biosimilars

On March 30, 2015, CMS released guidance addressing Medicare and Medicaid coverage for biosimilar drug products. The Medicare/Medicaid coverage guidance comes on the heels of the FDA’s landmark approval of a biosimilar...more

Washington Healthcare Update

This Week: CMS Releases Three Documents on Biosimilar Reimbursement... SCOTUS: Agencies, Not State Courts, in Charge of Medicaid Rate Setting... HHS OIG and Treasury IG Release Report on ACA’s Advanced Premium Tax Credits....more

CMS Releases Stage 3 Meaningful Use Proposed Rule

The Centers for Medicare & Medicaid Services (“CMS”) released the Stage 3 proposed rule to the Medicare and Medicaid Electronic Health Records Incentive Programs (“Proposed Rule”) on March 20, 2015. To provide context,...more

Health Care Fraud and Abuse Control (HCFAC) Program Reports $3.3 Billion in Recoveries

According to the FY 2014 HCFAC program report, more than $3.3 billion was recovered in FY 2014 as a result of the government’s health care fraud judgments and settlements, including $2.3 billion won or negotiated by the...more

HHS Publishes Proposed Stage 3 EHR Incentive Program, Health IT Certification Rules

On March 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule on Stage 3 meaningful use criteria, which focus on the advanced use of Electronic Health Record (EHR) technology to promote...more

Washington Healthcare Update

This Week: House Approves FY 2016 Budget Proposal... House Passes Permanent SGR Reform and Two-Year CHIP Reauthorization... Senate Passes FY 2016 Budget Plan... HHS Report: ACA Led to $7.4 Billion Decline in Uncompensated...more

HHS Releases Two Healthcare Information Technology Proposed Rules

On March 20, 2015, CMS and the HHS Office of the National Coordinator for Health Information Technology (ONC) released proposed rules regarding Stage 3 of the Medicare and Medicaid Electronic Health Records (EHRs) Incentive...more

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

This week, Alaska’s Governor introduced Medicaid expansion bills in both the House and Senate after failing to get approval in his budget. Colorado determined that non-ACA-compliant plans cannot be sold in 2016, a year ahead...more

GAO Seeks Stronger CMS Measurement of State Medicaid Program Integrity System Effectiveness

Based on a review of 10 state Medicaid Management Information Systems (MMIS) used to process claims and support program integrity efforts, the GAO has concluded that the effectiveness of these systems is not known because CMS...more

“Next-Generation ACO” Model Is CMS’s Newest Effort to Encourage More ACO Risk

On March 10, 2015, the Centers for Medicare & Medicaid Services’ (“CMS’s”) Center for Medicare and Medicaid Innovation (“Innovation Center”) announced a demonstration project incorporating new risk models for reimbursement of...more

CMS Rule on Medicare Overpayments? Don’t Hold Your Breath

Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a...more

Manatt on Health Reform: Weekly Highlights - March 2015 #2

King v. Burwell speculation has been rampant since the Supreme Court heard oral testimony on Wednesday. All eyes are on Justices Kennedy and Roberts, who are likely to wield the deciding votes. In other news, CMS approved a...more

CMS Delays Publication of Final Rule Regarding Reporting and Returning of Medicare Overpayments

One of the most challenging compliance changes brought about by the Affordable Care Act (ACA) is the provision mandating the reporting and refunding of Medicare and Medicaid overpayments within 60 days of the date they are...more

Medicaid Managed Care: What’s Ahead in 2015

Managed care is the dominant delivery model in state Medicaid programs, and is rapidly growing with the Affordable Care Act bringing over 8 million new beneficiaries into Medicaid in 2014. Today, 39 states (including the...more

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

Wrapping up the 2015 enrollment period, Healthcare.gov and State-based Marketplaces in seven states have announced special enrollment periods (SEPs) for people who were uninsured in 2014 and discover they owe a “shared...more

CMS Delays 60-Day Rule, But Overpayment Case Law Emerging

The Centers for Medicare & Medicaid Services (CMS) recently announced a one-year delay in finalizing the long-awaited and closely watched rule addressing the 60-day deadline to return Medicare and Medicaid overpayments (the...more

Washington Healthcare Update

This Week: President’s FY2016 Budget Request... FDA Commissioner Hamburg to step down... Tennessee Medicaid expansion plan rejected by legislature. 1. Congress House House Ways and Means Committee Hosts Hearing...more

CMS Extends Moratoria on Enrollment of New Providers and Suppliers in Six Locales

Last week, CMS announced that it has extended temporary moratoria on the enrollment of new ambulance suppliers and home health agencies within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania,...more

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