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

Also In The News - Health Headlines - September 2016 #3

CMS Rejects Ohio’s Section 1115 Medicaid Demonstration Waiver Application – On September 9, 2016, CMS denied Ohio’s application for a new demonstration section 1115 Medicaid waiver, citing concerns over the State’s request to...more

OIG Releases Series of Reports Focusing on Improper Medicaid EHR Incentive Payments

In August 2016, OIG released a series of reports focusing on the Medicaid electronic health record (EHR) incentive program for hospitals in West Virginia, Ohio, and Oklahoma. This continues a recent trend of reports focusing...more

HHS Proposes Changes to State Medicaid Fraud Control Unit Rules

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have proposed amendments to the regulations governing State Medicaid Fraud Control Units (MFCUs). The proposed rule would reflect...more

The Proposed Medicaid DSH Rule: Hospitals, States and Associations Declare It Legally Insufficient

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule addressing the treatment of third-party payments when calculating uncompensated care costs for the Medicaid disproportionate share...more

Strangest Regulatory Interpretation of the Month

The Massachusetts federal district court is hands-down winner of the August award for strangest regulatory interpretation of the month. The interpretation came in the context of denial of Omnicare’s summary judgment...more

Republican Lawmakers Voice Concern About Medicare Fraud Prevention

On September 12, 2016, Republican leaders of the House Ways and Means Committee, Energy and Commerce Committee, and Committee on Finance wrote a letter to the acting CMS administrator requesting information regarding CMS’s...more

PACE Program for Senior Care

On August 21st, the New York Times published an article on the PACE program for senior care. Up to now, PACE programs, which are intended to keep seniors living in their homes longer, as well as to cut down on the cost...more

The EpiPen Controversy Signals Intensifying Scrutiny of Drug Classification Under Medicaid Rebate Program

Price increases threatening the availability of EpiPen® and EpiPen Jr® Auto-Injectors (“EpiPen”) have touched off the latest firestorm over drug pricing. Lost amid the public outcry, however, is a thorny regulatory issue:...more

Manatt on Health Reform: Weekly Highlights - September 2016 #3

Study finds that Marketplace premiums are lower than employer-based premiums, even without federal subsidies; New York regulators move to shield insurers from outsized federal risk adjustment payments; and Missouri will seek...more

Health Care – The Fight Over the ACA Continues

Perhaps no issue has dominated the headlines during the Obama Administration more than the fight over the future of the American health care system. And while Secretary Clinton and Mr. Trump disagree over many health care...more

Office of Inspector General Urges CMS to Address Payment Issues Associated with DME-Covered Infusion Drugs

On September 7, 2016, the Office of Inspector General (OIG) released a report entitled “CMS Should Address Medicare’s Flawed Payment System for DME Infusion Drugs” (OEI-12-16-00340). This report is a follow-up to an April...more

OMIG Issues Guidelines on "Certifying Officials"

The Office of the Medicaid Inspector General (OMIG) recently published guidance affecting compliance program certifications each December. Effective this year, the “Certifying Official,” i.e., the person who submits the...more

Manatt on Health Reform: Weekly Highlights - September 2016 #2

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

Also In The News - Health Headlines - September 2016

Interim Final Rule Increases Civil Monetary Penalty Amounts – On September 2, 2016, the Department of Health and Human Services (HHS) released an interim final rule that “adjust[s] for inflation the maximum civil monetary...more

CMS Finalizes Emergency Preparedness Requirements for Medicare/Medicaid Providers

The Centers for Medicare & Medicaid Services (CMS) has released a long-awaited final rule establishing emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they...more

Raising Kane: CMS’s 60-Day Rule Commands More Than Treble Damages

In August 2015, we published a client advisory on the first judicial opinion interpreting the Affordable Care Act’s (ACA) “60-day overpayment rule,” which requires providers to “report and return” an overpayment of Medicare...more

CMS Seeks Input on “Evolution” of State Innovation Models Initiative, Including Potential Inclusion in MACRA Advanced Alternative...

CMS is soliciting public input on the “evolution” of its State Innovation Models (SIM) Initiative, which was launched in 2013 to accelerate state design and testing of multi-payer payment and delivery models to generate...more

OIG Finds New Jersey Medicaid Overpaid $2.2 Million in EHR Incentives

The HHS Office of Inspector General (OIG) recently reported that the New Jersey Department of Human Services (NJ DHS) made incorrect Medicaid electronic health record (EHR) incentive payments to 15 hospitals for a total of...more

Medicaid Managed Care Transitions’ Impact On Brain Injury Waiver Populations

As of June 2015, 24 states utilize a traumatic or acquired brain injury waiver,1 as provided under section 1915(c) of the Social Security Act, which are designed to help individuals with traumatic brain injury (TBI) live in...more

Congressional Health Policy Hearings, Markups Resume After Summer Break

Congress has returned from recess, and health care policy continues to be on the agenda. The following health-related hearings and markups were held this week: ..The House Ways and Means Committee approved H.R. 5942, a...more

First Circuit Adopts “Arm of the State” Test to Affirm Dismissal of FCA Complaint

In January 2016 in a matter of first impression, the First Circuit held that the University of Massachusetts Medical School is a state agency, and therefore not a “person” subject to liability in a False Claims Act (“FCA”)...more

Manatt on Health Reform: Weekly Highlights - September 2016

The national uninsurance rate hits a record low; Georgia’s Chamber of Commerce outlines three Medicaid expansion proposals; and California legislation targets surprise medical bills. FEDERAL AND STATE MARKETPLACE...more

The Materiality Standard In False Claims Actions

The Supreme Court decided Universal Health Services v. U.S. ex rel. Escobar on June 16, 2016 in which it ruled the implied false certification theory, previously recognized in several circuits, can form the basis for False...more

FDA Uses Summer to Issue Numerous Device Guidance Documents

The Agency shows no signs of slowing regulatory activity. Although the US Food and Drug Administration’s (FDA’s or the Agency’s) Center for Devices and Radiological Health (CDRH) has been very active throughout 2016, it...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

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