Editor’s Note: In a new white paper funded by Pfizer, Inc., Manatt Health discusses the current landscape of Medicaid and Children’s Health Insurance Program (CHIP) coverage and reimbursement for prenatal vaccines, informed...more
Prenatal vaccines provide important protection for pregnant women and newborns against communicable diseases such as whooping cough and influenza. However, fewer than one out of four pregnant women receives all federally...more
5/18/2023
/ Children's Health Insurance Program (CHIP) ,
Continuing Legal Education ,
Denial of Insurance Coverage ,
Fee-for-Service ,
Health Care Providers ,
Health Insurance ,
Infectious Diseases ,
MCOs ,
Medicaid ,
Payment Rates ,
Pharmaceutical Industry ,
Pharmacist ,
Physicians ,
Pregnancy ,
Reimbursements ,
Vaccinations ,
Webinars
Prenatal vaccines—those administered during a pregnancy—provide crucial protections to pregnant women and/or newborns against communicable diseases such as whooping cough and influenza. Additional prenatal vaccines are in...more
5/17/2023
/ Affordable Care Act ,
Children's Health Insurance Program (CHIP) ,
Fee-for-Service ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
MCOs ,
Medicaid ,
Medicare ,
Patient Access
The Inflation Reduction Act of 2022 (IRA) includes the most dramatic change to U.S. drug price regulation in history. The new law allows the federal government to “negotiate” the price of many drugs dispensed to Medicare...more
9/7/2022
/ Biosimilars ,
Continuing Legal Education ,
Drug Pricing ,
Generic Drugs ,
Health Care Providers ,
Inflation Reduction Act (IRA) ,
Manufacturers ,
Medicaid ,
Medicare ,
Medicare Beneficiaries ,
Medicare Part D ,
New Regulations ,
Pharmaceutical Industry ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
Section 340B ,
Webinars
The 340B Program’s Growing Scope -
The 340B program has grown significantly in scope. According to the Health Resources and Services Administration (HRSA), as of January 1, 2018, the 340B program included 12,823 providers...more
Editor’s Note: In a recent webinar, Manatt explained the complexities of the 340B program, which requires drug manufacturers to provide outpatient drugs to eligible healthcare entities at sharply reduced prices. The webinar...more
Editor’s Note: To help provide clarity on the interplay between Medicaid and 340B, Manatt Health has developed a 50-state survey on 340B, analyzing how state Medicaid programs reimburse 340B-covered entities and contract...more
Manatt, Phelps & Phillips, LLP, a multidisciplinary, integrated professional services firm, announced today the release of its Comprehensive 50-State Survey: State Medicaid Programs and 340B. Conducted by Manatt Health, the...more
Section 1332 Waivers: Will We See More State Innovation? -
Editor's Note: In a new essay for the National Institute of Health Care Management (NIHCM), summarized below, Manatt Health examines Section 1332 waivers and the...more
8/25/2016
/ 1332 Waiver ,
Assisted Suicide ,
Customer-Loyalty Programs ,
Department of Health and Human Services (HHS) ,
Discounts ,
Dispute Resolution ,
False Claims Act (FCA) ,
Federal Trade Commission (FTC) ,
Long Term Care Facilities ,
Medicaid ,
Off-Label Promotion ,
Patient Privacy Rights ,
PHRMA ,
Prescription Drug Coverage ,
Section 340B ,
Unfair or Deceptive Trade Practices
The Vulnerability of Healthcare Information -
According to a report the Brookings Institute issued in May 2016, 23% of all data breaches occur in the healthcare industry. Nearly 90% of healthcare organizations had some...more
7/28/2016
/ Abortion ,
Affordable Care Act ,
Anti-Steering Rules ,
Antitrust Violations ,
Attorney's Fees ,
Bad Faith ,
Brandt Fees ,
Children's Health Insurance Program (CHIP) ,
Compensatory Damages ,
Contraceptive Coverage Mandate ,
Cybersecurity ,
Data Protection ,
Denial of Benefits ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Medical Records ,
Employee Retirement Income Security Act (ERISA) ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Trade Commission (FTC) ,
Food and Drug Administration (FDA) ,
Gobeille v Liberty Mutual Insurance Com. ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Justice Scalia ,
Market Power ,
Materiality ,
Medicaid ,
Medical Devices ,
Medicare ,
Nurses ,
OCR ,
Patient Privacy Rights ,
PHI ,
Preemption ,
Punitive Damages ,
Religious Institutions ,
Right to Privacy ,
SCOTUS ,
Undue Burden ,
Universal Health Services Inc v United States ex rel Escobar ,
Wearable Technology ,
Whole Woman's Health v Hellerstedt ,
Zubik v Burwell
Real-Time Data Analytics in Government Investigations and Reducing Exposure -
It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more
6/24/2016
/ ACOs ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Government Investigations ,
Healthcare Fraud ,
HEAT ,
Hospital Mergers ,
IRS ,
MCOs ,
Medi-Cal ,
Medicaid ,
Medicare Advantage ,
OIG ,
Section 340B
On January 8, 2015, Tennessee released a proposal to expand its Medicaid program through an amendment to its current TennCare II waiver under Section 1115 of the Social Security Act. Tennessee’s two-year proposal, called...more
Social and economic factors such as income, educational attainment, access to food and housing, and employment status have a profound impact on health. In fact, these nonmedical factors account for as much as 40 percent of...more
On April 2, 2014, the New York State Office of the Medicaid Inspector General (OMIG or the Agency) released its Medicaid Work Plan (the Work Plan) for federal fiscal year 2014. OMIG’s core function is to prevent, detect, and...more
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
2/26/2014
/ Affordable Care Act ,
CLIA ,
Data-Sharing ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Federal Trade Commission (FTC) ,
Final Rules ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Hospital Mergers ,
Medicaid ,
Medical Records
Trend 1: New Wave of Medicaid Expansions: Looking to the Private Market. With an eye on the economics, states that have resisted Medicaid expansion will take another look, triggering a melding of public and private coverage...more