On June 27, the D.C. District Court struck down CMS’ 2020 approval of a 10-year renewal for the Healthy Indiana Plan (HIP) 2.0 Medicaid Section 1115 demonstration (Rose v. Becerra). In addition to the atypical 10-year...more
The New York State fiscal year 2024 – 2025 budget was signed on April 20, 2024, instituting, among many other provisions, a new tax on health plans, including insurers and managed care organizations. This tax has been...more
On February 26, 2024, Montana received Centers for Medicare and Medicaid Services (CMS) approval to provide contingency management, tenancy supports, and Reentry Initiative services under its Section 1115 Healing and Ending...more
This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for January 2024. We discuss several US Department of Health and Human Services (HHS) agency actions, including the new Innovation in...more
On January 9, 2024, the Centers forMedicare and Medicaid Services (CMS) approved New York’s request to amend its Medicaid section 1115 demonstration waiver, “Medicaid Redesign Team.”1 New York State announced that the...more
A key element of the Medicaid Redesign Team 1115 Waiver amendment is the Medicaid Hospital Global Budget Initiative (GBI), a reimbursement model tied very closely to the States Advancing All-Payer Health Equity Approaches and...more
On January 9, 2024, the federal Centers for Medicare and Medicaid Services (CMS) finally approved New York State’s 1115 waiver amendment to establish the New York Health Equity Reform (NYHER) Program. That application, which...more
On January 9, 2024, the Center for Medicare and Medicaid Services (CMS) sent a letter to New York’s Medicaid director approving New York’s Section 1115 Waiver amendment, which the state submitted for approval on September 2,...more
On June 30, 2023, the Centers for Medicare & Medicaid Services (CMS) approved Washington’s five-year Section 1115 demonstration renewal, the Medicaid Transformation Project 2.0 (MTP 2.0 or Demonstration). Through its renewed...more
Individuals leaving incarceration have disproportionately higher rates of physical and behavioral health diagnoses and are at higher risk for injury and death compared with people who have not been incarcerated. Race...more
Strong evidence suggests that investing in children’s social needs leads to long-term improvements in health, economic stability and resilience. Despite this growing body of research, stakeholders have historically...more
On February 28, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would change how Medicare disproportionate share hospital (DSH) payments are calculated with respect to the counting of...more
The Big Picture - On January 26, 2023, the Centers for Medicare & Medicaid Services (CMS) approved California’s request to amend the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration. A...more
The Big Picture - On January 4, the Centers for Medicare & Medicaid Services (CMS) issued a new State Medicaid Director (SMD) letter on how states can make expanded use of ILOS authority, including to address social...more
Editor’s Note: Section 1115 demonstrations (also called waivers) allow states to test new ways to operate their Medicaid programs, typically on matters related to eligibility, benefits and care delivery. Recently, the Centers...more
Editor’s Note: Section 1115 Medicaid demonstrations enable states to develop innovative programs for improving the health and well-being of Medicaid enrollees. Long-standing federal policy requires that 1115 waivers be...more
This fall, the Centers for Medicare & Medicaid Services (CMS) approved innovative 1115 waivers for Arizona, Massachusetts and Oregon, authorizing new financing and programmatic flexibilities for delivering services that...more
There is growing momentum among states to develop innovative models to help people involved with the justice system (i.e., justice-involved individuals) receive health care services covered by Medicaid while they are...more
Section 1115 of the Social Security Act permits the secretary of the Department of Health and Human Services to waive certain Medicaid program rules and provide federal funding for states to test innovative coverage and...more
More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. In December 2021, the Centers for Medicare & Medicaid Services (CMS) approved the...more
Hello readers! Today’s post focuses on a topic we’ve touched on a few times in the past – Medicaid drug formularies. Back in December 2021, the state of Oregon released a draft Medicaid waiver proposal that caught the...more
On January 22, 2022, Georgia and the Georgia Department of Community Health filed suit against the Centers for Medicare & Medicaid Services (CMS) seeking to prevent the rescission of the central aspects of Georgia’s 1115...more
On December 17, 2021, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2022 inpatient prospective payment system (IPPS) final rule. In light of the significant volume of comments, CMS declined...more
As the nation experiences unprecedented levels of behavioral health needs—even further exacerbated by the COVID-19 pandemic—state Medicaid programs have increasingly looked for flexibility to craft services and payment models...more
On March 17, 2021, HHS notified Arkansas and New Hampshire officials that it was withdrawing its approval of demonstration projects which had permitted those states to impose work requirements as a condition for eligibility...more