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’s Final Medicaid Rule Tweaks the Proposed Rules Related to Marketing, Physician Incentive Arrangements and Long-term Care

On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS), released the Medicaid managed care final rule entitled, “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP...more

Manatt on Medicaid: Monthly Expansion Recap - May 2016

Alaska - House Brings Medicaid Expansion Lawsuit to State Supreme Court - The Alaska House of Representatives has filed an appeal to the State Supreme Court seeking reinstatement of its lawsuit against Governor Bill...more

Manatt on Health Reform: Weekly Highlights - May 2016 #4

Uninsurance hit a record-breaking low of 9.1% in 2015; Vermont legislators pass a bill to increase drug formulary and price transparency; and California rolls out its State-funded Medi-Cal expansion to undocumented children....more

Manatt on Medicaid: Beneficiary Support and Enrollment Requirements

On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule that significantly overhauls regulations governing Medicaid managed care. The final rule establishes new requirements for...more

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

Maryland becomes the first State to mandate over-the-counter contraceptive coverage; Missouri plans to increase Medicaid asset limitations by 500% by 2021; and HHS' final rule extends protections against sex discrimination to...more

Manatt on Medicaid: Observations from New York's DSRIP Implementation

Editor's note: Medicaid is the largest healthcare payer in virtually every state. States are increasingly leveraging that position to drive payment and delivery system reform efforts. One powerful tool to enable...more

North Carolina Legislative Report

Lawmakers returned to Raleigh for the Regular Session April 25, 2016. The MVA Public Affairs Legislative Report on North Carolina will be distributed weekly during session to keep you up to date on the latest legislative...more

CMS Unveils Revised Voluntary Self-Referral Disclosure Protocol

On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to its Voluntary Self-Referral Disclosure Protocol (SRDP), through which providers may disclose actual or potential violations...more

First-of-its-Kind PACE Acquisition

PACE operators may become the next target of interest for healthcare private equity investors following a first-of-its-kind acquisition of a PACE operator by private equity sponsor Welsh Carson Anderson & Stowe (WCAS), which...more

Former Medicaid Auditor for D.C. Government Permitted to Proceed with FCA Retaliation Claim

The Federal District Court for the District of Columbia recently ruled that a former director of Medicaid audits in Washington D.C. can proceed with retaliation claims alleging he was fired for trying to stop his former...more

Massachusetts Long-Term Services and Supports: Achieving a New Vision for MassHealth

Long-term services and supports (LTSS) enable hundreds of thousands of people of all ages in Massachusetts to live with independence and dignity, participate in their communities and increase their overall quality of life....more

Manatt on Medicaid: CMS Finalizes Overhaul of Medicaid and CHIP Managed Care Rules

Overview - On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) released its highly anticipated final rule to overhaul the regulatory framework governing Medicaid managed care and make conforming...more

CMS Adds New Quality Measures To Nursing Home Compare Website

To help residents and their families find a quality Medicare or Medicaid certified nursing home and to encourage nursing homes to achieve high quality by public reporting of quality measures, in 1988 the Centers for Medicare...more

CMS’s Final Medicaid Rule Creates a Medicaid MLR Framework but Leaves Room for State Variation

In Depth - The final Medicaid managed care rule issued by the Centers for Medicare & Medicaid Services (CMS) on April 25, 2016, (the Final Rule) establishes a new federal medical loss ratio (MLR) standard for Medicaid...more

Medicaid and CHIP Managed Care Final Rule: It’s All About Consistency

The Centers for Medicare & Medicaid Services (CMS) recently issued a 1,425-page regulation (Rule) on managed care in Medicaid and the Children’s Health Insurance Program (CHIP), dubbed the first overhaul of these regulations...more

Manatt on Medicaid: Massachusetts Releases Details on Forthcoming DSRIP Waiver Proposal

Medicaid Accountable Care Organizations - On April 14, 2016, the Massachusetts Executive Office of Health and Human Services released new details on a proposed restructuring of the MassHealth (Massachusetts Medicaid)...more

New OIG Exclusion Guidance

On April 18, 2016, the Department of Health and Human Services Office of the Inspector General (“OIG”) issued revised criteria for implementing permissive exclusion authority. These revisions are a non-binding policy...more

Already Enormous False Claims Act Penalties Set to Increase

The already enormous per-claim penalties under the federal False Claims Act (“FCA”) may nearly double by August 1, 2016, ratcheting up the stakes of FCA cases for health care providers, pharmaceutical and medical device...more

CMS Finalizes Major Reforms of Medicaid/CHIP Managed Care Rules

On May 6, 2016, CMS is publishing a final rule to update Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to more closely align with Medicare Advantage (MA) and private health plan standards,...more

OIG Examines State Implementation of Correct Coding Edits for Medicaid Payments

The HHS Office of Inspector General (OIG) recently issued a report examining implementation of Medicaid National Correct Coding Initiative (NCCI) edits, as required by the Affordable Care Act since October, 2010. The report...more

CMS Update to Medicaid Managed Care Regulations Should Prompt Significant Change

The Centers for Medicare & Medicaid Services (“CMS”) has released the final version of its much anticipated revisions to the regulations governing Medicaid managed care (the “Final Rule”). First proposed in May 2015, the...more

CMS Issues Final Rule for Medicaid and CHIP Managed Care

On April 25, 2016, CMS released a Final Rule that will update regulations governing Medicaid and Children’s Health Insurance Program (“CHIP”) managed care plans. This Final Rule is the first major update to the Medicaid and...more

False Claims Act Liability Based on Implied Certification

When the U.S. Supreme Court granted certiorari in Universal Health Services v. United States ex rel. Escobar in late 2015, health care providers began optimistically awaiting a decision. This case is expected to decide...more

2016 Stark Law Updates

Centers for Medicare and Medicaid Services (CMS) issued the 2016 Medicare Fee Schedule (the "Schedule") in an effort to facilitate compliance with the Physician Self-Referral Law (the "Stark Law"). Generally, absent an...more

CMS Finalizes Updated Fire Safety Standards for Health Care Facilities

On May 4, 2016, CMS is publishing a final rule amending fire safety standards applicable to the following types of Medicare- and Medicaid-participating health care facilities: hospitals, critical access hospitals, long-term...more

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