Social Security Act

News & Analysis as of

U.S. Department of Health and Human Services Updates Criteria for Permissive Exclusion Under Section 1128(b)(7) of the Social...

The HHS-OIG issued new guidelines on April 18, 2016 regarding the Secretary's exercise of the Department's permissive exclusion authority pursuant to Section 1128(b)(7) of the Social Security Act. The HHS-OIG's new guidance...more

Blog: OIG Releases Criteria For Implementing Exclusion Authority

On April 18, 2016, the Health and Human Services Office of Inspector General (OIG) released updated guidance related to the criteria it may use for evaluating its permissive exclusion authority under Section 1128(b)(7) of the...more

OIG Issues New Guidance on Its Evaluation Process and Non-Binding Criteria for Section 1128(b)(7) Exclusions

On April 18, 2016, the Office of Inspector General (“OIG”) of the Department of Health and Human Services issued a revised policy statement applicable to exclusions imposed under Section 1128(b)(7) of the Social Security Act...more

Manatt on Medicaid: CMS Approves Alabama's Delivery System Reform Waiver

On February 9, 2016, the Centers for Medicare and Medicaid Services (CMS) approved Alabama's request for a waiver under Section 1115 of the Social Security Act. The waiver enables the transition of the State's Medicaid...more

4 Key Things to Watch on Recent Finding Related to Medicare Appeals Backlog

On Feb. 9, 2016, the D.C. Circuit found that the lower court has the authority to order the Department of Health & Human Services (HHS) to resolve the massive backlog of Medicare appeals tied up in the administrative law...more

Alabama Approved for Statewide Medicaid Managed Care

Alabama Governor Robert Bentley announced on February 9, 2016, that the State has been granted a waiver pursuant to Section 1115 of the Social Security Act (1115 waiver), authorizing Alabama to change the delivery of Medicaid...more

The 60-Day Rule Is Final: Assessing Your Organization’s Safeguards

Follow these tips to ensure compliance in the wake of the new 60-Day Rule. On February 12, the CMS finalized the 60-Day Overpayment Report and Refund rule (60-Day Rule) for Medicare Parts A and B. This long-awaited rule...more

CMS Grants California’s Request for Five-Year Medicaid Waiver

On December 30, 2015, CMS approved California’s request for a five-year waiver to extend California’s Section 1115(a) demonstration project, entitled “California Medi-Cal 2020 Demonstration.” According to the CMS approval...more

President Obama Signs Bill to Encourage PACE Program Innovation

On November 5, 2015, President Obama signed into law S. 1362, the Program of All-Inclusive Care for the Elderly (PACE) Innovation Act. The PACE Innovation Act authorizes the Secretary of Health and Human Services (HHS) to...more

Bipartisan Budget Act Jacks Up Civil Monetary Penalties Under the Social Security Act and False Claims Act Penalties

The Bipartisan Budget Act of 2015 (H.R. 1314), signed into law by President Obama November 2, 2015, will increase the civil monetary penalties (CMPs) imposed under the Social Security Act (SSA) in addition to False Claims Act...more

Are you giving the correct pension increases?

Pension increases in defined benefit schemes have become increasingly complex and contentious, not least because of the significant funding costs they involve. The recent decision in Dutton v. FDR Limited [2015] EWHC 2946...more

Budget Proposal Would Limit Provider-Based Status - New Off-Campus Departments Limited to Physician Fee Schedule or ASC Payment...

On October 26, 2015, Congressional and White House budget negotiators released the legislative text of the Bipartisan Budget Act of 2015. The Act is aimed primarily at lifting the Federal debt limit and avoiding a looming...more

2016 Cost of Living Increases are Rare

On October 21, 2015, in Information Release 2015-118, the IRS announced cost-of-living adjustments to various dollar limitations under the Internal Revenue Code (the "Code") for pension plans and other related items for the...more

Health Care Update - October 2015

Cuts in Mandatory Entitlement Programs Center of Budget Negotiations: As budget negotiators from both sides of the Hill come together to work out a two-year budget deal, determining how sequestration relief will be paid for...more

Adults with Special Needs May Soon Be Able to Streamline the Process to Establish First Party Special Needs Trusts on Their Own: A...

In 1993, Congress enacted Section 1917(d)(4)(A) of the Social Security Act, authorizing the establishment of special needs trusts (also called first-party trusts and self-settled trusts). First-party special needs trusts...more

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

Trends & Analysis: ..We have identified 15 health care–related qui tam cases that were unsealed since our last Qui Tam Update. Of those, 12 were filed from 2012 to the present. All but two cases had been pending more...more

CMS Proposes Lab Data Collection Requirements to Update Fee Schedule

On September 25, 2015, CMS released proposed rulemaking that would extensively revise payment and reporting requirements for clinical diagnostic laboratory tests (CDLTs), as paid on the Clinical Laboratory Fee Schedule...more

Employers Must Withhold FICA Taxes for Students who Change Status to H-1B Starting October 1

As students and scholars’ status change from F-1, J-1 or other FICA exempt statuses to H-1B starting October 1, these employees will become subject to FICA taxes upon the effective date of their H-1B status....more

Congressional Hearings to Focus on Health IT, Biosimilars, Medicaid Program Legislation

Two Congressional committees are holding hearings this week on health policy issues. First, the Senate Health, Education, Labor and Pensions (HELP) Committee has scheduled a September 16, 2015 hearing on “Achieving the...more

Washington Healthcare Update

This Week: House Energy and Commerce Subcommittee Holds Hearing on Legislation to Strengthen Medicaid Program Integrity and Fraud Controls... Bipartisan Senate Bill Introduced to Stop Anti-Competitive “Pay-For-Delay”...more

Outpatient Observation Status Bill Sent to President Obama

On July 27, 2015, the Senate approved by unanimous consent the Notice of Observation, Treatment and Implication for Care Eligibility (NOTICE) Act, H.R. 876. The NOTICE Act, if signed by President Obama, would amend title...more

Home and Community-Based Services: Seven Things You Need to Know

Few people have a strong understanding of home and community-based services (HCBS), how they work, how they came about and why they are important. There are a number of reasons why HCBS experts are few and far between. Put...more

California Appellate Court Holds Employer Must Withhold Taxes on Back Pay

On June 26, 2015, a California appellate court rendered a precedential opinion that should hopefully put to rest the issue of whether an employer must withhold taxes on settlements or judgments made to former employees in...more

Obergefell v. Hodges – Same-Sex Marriage Now Legal in All 50 States

In 2013, the Supreme Court, in United States v. Windsor, struck down Section 3 of the Defense of Marriage Act (“DOMA”) which defined marriage, for Federal purposes, as between one man and one woman. The Windsor ruling...more

Medicaid managed care proposed rule expands program integrity obligations

On June 1, 2015, the US Centers for Medicare & Medicaid Services (“CMS”) published its proposed rule on Medicaid managed care (CMS-2390-P). As noted in our two earlier advisories, which provided an overview of the proposed...more

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