Medicare Medicaid

News & Analysis as of

Medicare and Medicaid Drug Policy Provisions in the Obama Administration’s Proposed FY 2017 Budget

The Obama Administration’s proposed fiscal year (FY) 2017 budget, released on February 9, 2016, includes a number of legislative proposals that would revise Medicare and Medicaid policies to achieve budget savings and make...more

Medical Home Plans Saved Minnesota $1 Billion from 2010-2014

A five-year study released by the Minnesota Department of Health this week, which recorded reams of data in comparing traditional primary care practice patient and cost results with those of health care home practices...more

Also In The News - Health Headlines - January 2016 #4

CBO Projects Medicare Spending Growth – In a report published January 25, 2016, the Congressional Budget Office (CBO) estimates that expenditures for Medicare, Medicaid, and other major healthcare programs will equal...more

Government Reports Compile Medicaid, Dual Eligible Beneficiary Spending, Enrollment Data

The Government Accountability Office (GAO) has issued a report on trends in Medicaid managed care spending, enrollment, and oversight. Notably, the GAO reports that over 10 years (FY 2004 through 2014), federal Medicaid...more

Drug Manufacturer Discount Cards: Accept With Caution

Pharmaceutical manufacturer discount card usage by government program beneficiaries has been an active area for government action in recent years. In a September 2014 Special Advisory Bulletin, the U.S. Department of Health...more

CMS Announces Extension of Moratoria on Enrollment of HHAs, Ambulance Suppliers in Designated Areas

CMS published a notice February 2, 2016 announcing an additional 6-month extension of its current temporary Medicare enrollment moratoria for new ground ambulance suppliers and home health agencies (HHAs), subunits, and...more

Criminal Conviction Leaves Defendant Defenseless in FCA Civil Action

Pity Dr. Christina Clardy. In 2011 she was convicted of health care fraud, sentenced to 135 months in prison, and ordered to pay $16 million in restitution. Then in 2014 the government added Christina as a defendant in its...more

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

Louisiana's Governor pushes ahead on Medicaid expansion, while expansion is blocked by Wyoming's Legislature; Massachusetts plans to submit a 1332 waiver application to preserve its merged markets; and CBO lowers its 2016...more

Health Update - January 2016

The Megatrends Reshaping Healthcare: Managing Change and Maximizing Opportunity - Editor's Note: In 2013, Manatt Health identified 10 megatrends that would reinvent the healthcare marketplace across the next decade. In a...more

CMS Launches New “Accountable Health Communities” Innovation Model

CMS’s latest innovation model, the Accountable Health Communities model, will test whether screening for health-related social needs, providing community service referral and navigation, and encouraging partner alignment...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: December 2015

Trends & Analysis - We have identified 24 health care–related qui tam cases that have been unsealed since our last Qui Tam Update. Of the 24 cases, five were filed within the past year, seven were filed in 2014, three...more

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

HealthCare.gov enrolls 8.2 million; Manatt and RWJF release an open access dataset on Marketplace plans nationwide; Montana names administrator for its Medicaid expansion; and Michigan gets the green light in the nick of time...more

Congressional Leaders Announce Spending/Tax Deal with Medicare and ACA Provisions; House Approves Tax Package

On December 15, 2015, Congressional leaders released sweeping spending and tax proposals, including a number of provisions impacting Medicare and the Affordable Care Act (ACA). The legislation is being considered on a fast...more

Bills Introduced to Modify Payments for DMEPOS

Two bills have been introduced in the House of Representatives and the Senate to modify payments for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). On November 19, 2015, Senator John Thune (R-SD)...more

Centers for Medicare & Medicaid Services Releases Fee Schedule Amounts for DMEPOS for 2016

On November 23, 2015 the Centers for Medicare & Medicaid Services (CMS) announced the fee schedules for 2016 for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). For items and services not included in...more

2016 Medicare, Medicaid, CHIP Provider Enrollment Application Fee Announced

CMS has announced that the CY 2016 provider enrollment application fee is $554, up slightly from $553 in 2015. This application fee is required for institutional providers that are initially enrolling or revalidating...more

OIG Examines Medicare Part B Payments for 340B Purchased Drugs

A new OIG report reviews Medicare Part B spending on drugs purchased by eligible health care providers through the 340B drug discount program. The OIG describes the report as “an independent analysis to inform the ongoing...more

OIG Report Examines Potential Scenarios for Restructuring 340B Program

Restructuring the 340B Drug Discount Program and Part B payment rules could reduce Medicare drug expenditures by up to $1.1 billion, the HHS Office of Inspector General (OIG) reported last week. The 340B Program requires...more

CMS Proposes Restrictions on Arbitration Provisions in Nursing Home Resident Agreements

The use of a binding arbitration provision in the pre-admission agreement between a senior living facility and its resident has become quite common. If properly drafted and presented to the resident or his or her...more

OIG Issues HHS Fiscal Year 2016 Work Plan

The Work Plan describes more than 100 initiatives, including 43 new initiatives for the upcoming year. On November 2, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) issued its...more

Ignorance is Not Bliss: Get to Know the OIG FY 2016 Work Plan

The Department of Health and Human Services Office of Inspector General (HHS-OIG) recently released its FY 2016 Work Plan, in which it identified key areas of focus for the upcoming year. Consistent with its mandate to detect...more

CMS Update on Medicare-Medicaid Plan Quality Ratings Strategy

CMS has provided an update on vision for developing a star rating system for Medicare-Medicaid Plans (MMPs). While CMS does not expect to have the full star rating system in place during the testing of the...more

HHS OIG FY 2016 Work Plan Outlines Oversight Priorities

The HHS OIG has released its FY 2016 Work Plan, which outlines the top audit, evaluation, and other legal and investigative initiatives that the OIG intends to conduct this fiscal year. As in years past, Medicare and Medicaid...more

Bipartisan Budget Law Extends Medicare Sequestration, Includes Medicaid Drug Rebate, Off-Campus Hospital Outpatient Department,...

On November 2, 2015, President Obama signed into law H.R. 1314, the “Bipartisan Budget Act of 2015” (BBA). The two-year, $80 billion budget/debt-ceiling deal is funded in part by several significant Medicare and Medicaid...more

Also In The News - Health Headlines - November 2015

CMS Publishes Medicaid Access Final Rule – CMS published a Final Rule in the Federal Register today, November 2, 2015, that implements a process for states to determine whether Medicaid payments satisfy what is known as the...more

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