Medicaid Dept. of Health and Human 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

Health Care Reform Implementation Update - April 21, 2014

On April 14, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) reported their findings that show a smaller rise in insurance premium costs under the Affordable Care Act (ACA) than previously...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

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

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

OIG Releases Report on Medicaid Fraud Control Units

The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2013 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCU)...more

Highlights from OMHA's Medicare Appellant Forum

The Office of Medicare Hearings and Appeals (OMHA) recently announced that for most hearing requests received after April 1, 2013, it will be deferring assigning to Administrative Law Judges (ALJs). OMHA will continue to...more

Long Island Radiology Group Settles FCA Allegations That It Billed Medicaid And Medicare For Unnecessary Tests For $15.5M

A company operating diagnostic testing facilities in New York has agreed to pay $13.65 million to the federal government and $1.85 million to New York and New Jersey for a total of $15.5 million in penalties to settle claims...more

Health Care Reform Implementation Update - February 26, 2014

Though Congress was in recess this past week, congressional staff was hard at work continuing to consider ways to prevent a cut to Medicare providers’ payment rates that will be triggered by the sustainable growth rate...more

Health Update - Feb 25, 2014

Integrating Physical and Behavioral Health: Strategies for Overcoming Legal Barriers to Health Information Exchange - A growing number of Medicaid officials believe that coordinating care across the physical and...more

Marketing to Medicaid Beneficiaries: Texas Proposed Rule Highlights Pitfalls for Providers

Earlier this month, the Texas Health and Human Services Commission (Commission) released a proposed rule, 1 TAC § 354.1452 that prohibits certain marketing activity by Medicaid and CHIP providers. The proposed rule has been...more

OIG Reports on Contract Pharmacy Arrangements in the 340B Program

On February 4, 2014, the U.S. Department of Health and Human Services, Office of the Inspector General (OIG) issued a memorandum report regarding contract pharmacy arrangements in the 340B Program. In its report, OIG found...more

OIG Issues Report on Contract Pharmacy Arrangements Under the 340B Program

According to a recently posted report by the Department of Health and Human Services Office of Inspector General (OIG), covered entities utilizing contract pharmacies to dispense drugs under the 340B Drug Pricing Program (the...more

New Privacy Rule Gives Patients Right To Access Lab Test Reports

On February 6, 2014, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR) issued a final rule amending the Clinical Laboratory Improvement...more

MCOs Terminating Providers and Restricting the Freedom of Choice of Providers for Medicaid Recipients: Going To Far?

Who remembers Dennis Kozlowski? He is the former CEO of Tyco International, and his net worth is estimated at $600 million. However, his residence? A mansion? On his own island? Nope. He is currently serving 8.33 to...more

DHHS Blunder Could Cost Millions! “Oops I Did It Again!”

We can add one more “oops” to the Department of Health and Human Services (DHHS) repertoire of “oopses.” I am reminded of Captain Edward Smith when he banged the Titanic into an iceberg. Talk about an “oops” moment. Not to...more

The Affordable Care Act Comes Of Age

Since President Obama signed the Patient Protection and Affordable Care Act (ACA) in March 2010, various provisions of the law have taken effect. However, its core pieces become effective this year....more

Health Care Reform Implementation Update - December 19, 2013

The deadline to enroll in coverage for January 1 was officially extended by a week, but the new December 23 deadline is fast approaching, and premium payments are required to be paid by the last day of 2013 for January 2014...more

CMS Declares the Payment Structure for the MCOs Violates A-87…”So What Happens Now?”

In North Carolina, we set up managed care organizations (MCOs) to manage behavioral health care for Medicaid. For the past year, I have been blogging that the MCOs’ payment arrangement with the Department of Health and Human...more

Attention Medicaid Providers: Potential SPA Decreases PCS Rates By 60 Cents Per 15 Minutes

The North Carolina State Medicaid Plan (State Plan) is constantly revised. The result of its constant revisions make for an 1800+ page, jumbled mess of plans, rules, amendments, and effective dates that make the State Plan...more

To Decrease Medicaid Spending (Without Decreasing Medicaid Recipients’ Services), Drastic Administrative Cuts Are Needed

It is indisputable that reigning in Medicaid costs is one of this administration’s top priorities. And, I agree, reigning in Medicaid costs should be a top priority. In fiscal year 2011, it is estimated that Medicaid...more

DHHS Still Claims NCTracks on Track?? CSC Doing Its Best?

Today the Joint Legislative Oversight Committee on Health and Human Services met at noon. Mr. Joe Cooper, DHHS’ Chief Information Officer, spoke on behalf of DHHS. He began by explaining that NCTracks is not NC Fast, which...more

DHHS Takes 35 Years to Become Federally Compliant With Medicare/Medicaid Crossover Issues

It is without question that the implementation of NCTracks has been a complete debacle. NCTracks is the new computer system that is processing Medicaid claims for all health care providers who accept Medicaid in North...more

Health Reform + Related Health Policy News - October 2013 - Issue 3

In This Issue: - Top News ..Deal to Raise Debt Ceiling, End Shutdown Yields No Major Changes to Health Care Law ..Problems with HealthCare.gov Website Continue; HHS Working to Fix Issues ..Kaiser Study...more

Wanted: North Carolina Medicaid Director: Transparent and Open!

With Carol Steckel’s abrupt resignation September 27, 2013, only 8 months after accepting the job as NC Medicaid Director, we North Carolinians were left without a Medicaid Director. I posted a week or so ago that I can only...more

Health Reform + Related Health Policy News - October 2013

In This Issue: - Top News ..Judge Orders $237.4 Million Penalty Against Tuomey for Stark Law and False Claims Act Violations ..Glitches and Demand Lead to Marketplace Frustration ..HHS Delays Small...more

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