News & Analysis as of

Eligibility Healthcare

Manatt, Phelps & Phillips, LLP

Oregon Launches a Basic Health Program

On July 1, Oregon launched a Basic Health Program (BHP) that offers comprehensive health care coverage, including medical, dental, and behavioral health care, with zero premiums and zero cost-sharing for eligible individuals...more

Foley Hoag LLP - Medicaid and the Law

CMS Issues Rule Implementing Medicaid Redetermination Policies

We’ve written recently about the process that states are undertaking to begin to wind down the Medicaid enrollment expansion that was necessitated by the enactment of the Families First Coronavirus Response Act in March of...more

Seyfarth Shaw LLP

NPDB Waives Query Fees from March through May 2020

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To assist hospitals in credentialing physicians during the COVID-19 pandemic, the National Practitioner Data Bank (“NDPB”)—the federal clearinghouse for adverse action reports against physicians—has announced it is waiving...more

Foley & Lardner LLP

COVID-19: Resources for Oncology Providers (Medicaid, Grants, & Stark Law Waivers)

Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS), the Office for Civil Rights (OCR), the Office of the Inspector General (OIG), and other Federal and State agencies and...more

Seyfarth Shaw LLP

HHS Issues Advisory Opinion on PREP Act: Immunity May Extend Beyond Actual Covered Persons and Approved Countermeasures

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With crisis comes uncertainty, and even the best-intentioned regulations can leave those combating the current COVID-19 public-health emergency out in the cold.  Many have asked whether the recent Declaration under the...more

Seyfarth Shaw LLP

Health CARES – How the CARES Act Impacts Health Care Providers

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Congress passed and the President signed the CARES Act on March 27, 2020. The Act impacts hospitals, post-acute providers and long term care facilities in numerous ways. The following is an outline of key provisions and their...more

King & Spalding

CMS Releases Tools to Support States’ Medicaid and CHIP Programs During the COVID-19 Outbreak

King & Spalding on

On March 22, 2020, CMS announced a suite of four new tools intended to help states combat the coronavirus by allowing states to streamline enrollment into long-term care and home-based services and by expediting application...more

Seyfarth Shaw LLP

CMS Announces New Priorities for Facility Surveys and Inspections

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In light of findings from the COVID-19 outbreak at a nursing home in Kirkland, Washington, the Centers for Medicare and Medicaid Services (CMS) has announced that it will suspend all routine facility inspections and surveys...more

Manatt, Phelps & Phillips, LLP

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

HHS announces average premium price increases of 7.5% across HealthCare.gov; Michigan and Illinois launch the country’s first joint cloud-based, real-time Medicaid information management system; and the Marketplace carrier...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: Medicaid at 50—The Program’s Evolution and Future

Editor’s note: Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs into the nation’s largest health insurer. Medicaid’s 50th birthday is a fitting time to...more

Pullman & Comley, LLC

Alert: Proposed 340B Drug Pricing Program Omnibus Guidance - Defines "Eligible Patient"

Pullman & Comley, LLC on

On August 28, 2015, the Health Resources and Services Administration (“HRSA”) published the proposed 340B Drug Pricing Program Omnibus Guidance (“Omnibus Guidance”) which is intended to clarify for covered entities, such as...more

Baker Donelson

Obama Signs Bill Making Changes to Affordable Care Act

Baker Donelson on

On October 7, President Obama signed into law H.R.1624, the Protecting Affordable Coverage for Employees Act. The act amends a provision of the Affordable Care Act (ACA) to allow states to opt out of the scheduled expansion...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - September 2015 #5

New study shows Marketplace premiums parallel the employer market; Montana likely to select a private insurer to administer benefits to its Medicaid expansion population; and Washington’s Exchange customers will begin paying...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - September 2015

CMS permits states to use income information from other means-tested benefit programs for Medicaid eligibility determinations; Alaska’s Medicaid expansion is given the green light to launch today; and Washington State submits...more

King & Spalding

Outpatient Observation Status Bill Sent to President Obama

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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

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - July 2015 #3

In quick succession, governors in Alaska and Utah announce Medicaid expansions this week; Iowa is transitioning its expansion away from the Marketplace to Medicaid managed care, for now; and, HHS extends its exception to...more

Foley & Lardner LLP

MSSP Final Rule ACO Eligibility Requirements, Application and Renewal Process

Foley & Lardner LLP on

This is the second post in Health Care Law Today’s series on the final rule. This post addresses Eligibility Requirements, and the Application and the Renewal Process. ACO Eligibility Requirements - Under the...more

Proskauer - Employee Benefits & Executive...

Final Regulations on Orientation Periods Released

On June 20, the Federal regulatory agencies in charge of health care reform guidance (the Departments of Labor, Treasury, and Health and Human Services) released final regulations (“Final Regulations”) clarifying the...more

Manatt, Phelps & Phillips, LLP

Health Update - Feb 25, 2014

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

King & Spalding

Congressional Budget Office’s estimate on budgetary effects of raising Medicare eligibility age to 67

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On October 24, 2013, the Congressional Budget Office (CBO) released an updated estimate on the potential impact of raising Medicare’s eligibility age. Medicare costs are expected to rapidly increase in coming years due to...more

Cole Schotz

New Jersey Court Exceeded Its Authority in Determining Future Medicaid Eligibility

Cole Schotz on

A recent New Jersey Appellate Division opinion determined the limits of a lower court’s jurisdiction with respect to deciding Medicaid eligibility. The Appellate Division in In re A.N., 430 N.J. Super. 235 (2013), found that...more

BakerHostetler

Health Care Reform's 90-Day Waiting Period Guidance for Group Health Plans Deserves a Closer Look

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One of the many requirements bearing down on group health plans in 2014 is the 90-day waiting period rule found in section 2708 of the Public Health Service Act (PHS Act), as added by the Affordable Care Act (ACA)....more

Manatt, Phelps & Phillips, LLP

Simplified, Real-Time Verification Issue Brief

The Affordable Care Act (ACA) requires a coordinated and streamlined eligibility and enrollment process for all Insurance Affordability Programs (IAPs), including Medicaid, the Children’s Health Insurance Plan (CHIP), and...more

Cozen O'Connor

Hospitals Prevail in Effort to Include Pennsylvania GA Days in the Medicare DSH Calculation

Cozen O'Connor on

Two of Mercy Health System’s hospitals (Nazareth Hospital and the former St. Agnes Medical Center) successfully challenged, before Judge Ludwig of the U.S. District Court for the Eastern District of Pennsylvania, the...more

Poyner Spruill LLP

Health Reform - New Guidance On Eligibility Waiting Periods (or, when is 90 days not 90 days?)

Poyner Spruill LLP on

Starting in 2014, federal law will prohibit group health plans from imposing eligibility waiting periods longer than 90 days. Recently, federal regulators published proposed regulations designed to implement this limitation....more

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