News & Analysis as of

Health Insurance MCOs

Sheppard Mullin Richter & Hampton LLP

CMS Issues Final Rule on Medicaid and CHIP Managed Care Access, Finance, and Quality

On April 22, 2024, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-2439-F), effective July 9, 2024, aimed at advancing healthcare access,...more

McDermott+

CMS Finalizes Major Reforms to Medicaid, Part 2: Medicaid Managed Care Reg

McDermott+ on

Medicaid Regs Part 2! Last week, Regs & Eggs took a deep dive into the Ensuring Access to Medicaid Services final reg, one of two regs that the Centers for Medicare & Medicaid Services (CMS) released to add new requirements...more

Manatt, Phelps & Phillips, LLP

Prenatal Vaccines in Medicaid and CHIP: Coverage, Reimbursement and State Policy Solutions

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

Manatt, Phelps & Phillips, LLP

[Webinar] Prenatal Vaccines in Medicaid & CHIP: Current State Payment Rates and Strategies to Increase Access - June 8th, 2:00 pm...

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

Manatt, Phelps & Phillips, LLP

Prenatal Vaccines in Medicaid and CHIP: Coverage, Reimbursement, and State Policy Solutions to Increase Access

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

American Conference Institute (ACI)

[Event] 14th Annual Advanced Forum on Managed Care Disputes and Litigation - March 29th - 30th, Chicago, IL

Hosted by ACI, 14th Annual Advanced Forum on Managed Care Disputes and Litigation returns for another exciting year with curated programming that will help you make sense of these developments, and their profound impact on...more

Manatt, Phelps & Phillips, LLP

OMIG Proposes Omnibus Regulations Impacting Medicaid Providers’ and Plans’ Compliance Obligations

On July 13, 2022, the New York State Office of Medicaid Inspector General (OMIG) published proposed rules in the New York State Register to implement provisions of the State Fiscal Year 2020-2021 Enacted Budget and the...more

Manatt, Phelps & Phillips, LLP

[Webinar] In Pursuit of Whole-Person Health: A Review of Drivers of Health Initiatives in Medicaid Managed Care - July 25th, 1:00...

Mounting evidence indicates that addressing the social and economic factors that drive the majority of health outcomes, often called social drivers of health (DOH), can improve health, promote health equity and reduce costs....more

Manatt, Phelps & Phillips, LLP

[Webinar] Health Care Litigation Trends to Watch in 2022…and Beyond - April 27th, 4:00 pm - 5:00 pm ET

Health care is facing a tidal wave of change—from enforcement actions around CARES Act funding to employment issues in a post-COVID workplace to questions around telehealth coverage to controversies over gender identity...more

Manatt, Phelps & Phillips, LLP

The Role of Medicaid in Addressing Social Drivers of Health: MCO Community Investment Requirements

Increasingly, states are using their Medicaid managed care (MMC) contracts to define the role Medicaid and Medicaid managed care plans can play in addressing unmet social needs and promote a “whole person” approach to care. A...more

Carlton Fields

FOIR Releases Guidance on New Disclosure Requirements for Health Insurers, MCOs

Carlton Fields on

The Florida Office of Insurance Regulation released an informational memorandum on Friday to all health insurers and managed care organizations authorized to do business in Florida to provide guidance regarding new disclosure...more

Manatt, Phelps & Phillips, LLP

[Webinar] Medicaid Managed Care Payment Policies to Support Pediatric Providers - December 7th, 3:30 pm - 4:30 pm ET

What Actions Can State Medicaid Agencies and Medicaid Managed Care Organizations Take to Support Financial Stability for Pediatric and Other Primary Care Practices During the COVID-19 Pandemic? Find Out in a New Webinar From...more

Manatt, Phelps & Phillips, LLP

In Pursuit of Whole Person Health: Leveraging Medicaid Managed Care & 1115 Waivers to Address SDOH

Editor’s Note: In a new report, Manatt explores how states are using two key tools—Medicaid managed care contracts and 1115 waivers—to address the unmet social needs of people with Medicaid coverage. The findings have...more

American Conference Institute (ACI)

[Virtual Event] 11th Annual Advanced Forum on Managed Care Disputes and Litigation - July 22nd-23rd

ACI’s 11th Annual Advanced Forum on Managed Care Disputes and Litigation will be offered in a virtual format this year to help you make sense of these developments, and their profound impact for managed care....more

Sheppard Mullin Richter & Hampton LLP

HHS Proposes Rule to Eliminate Safe Harbor for PBM Drug Rebates

On February 6, 2019, the Office of the Inspector General of the U.S. Department of Health and Human Services (the “OIG”) published in the Federal Register a proposed rule (the “Proposed Rule”) that, if made final in its...more

Epstein Becker & Green

HHS OIG Proposes Anti-Kickback Safe Harbor Amendments to Regulate and Restrict the Provision of Manufacturer Remuneration to Plan...

On January 31, 2019, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued a proposed rule (“Proposed Rule”) that would restrict safe harbor protection under the federal Anti-Kickback...more

Bass, Berry & Sims PLC

OIG Proposed Rule Seeks to Address Drug Pricing Concerns – But Will It?

In an effort to respond to prescription drug pricing concerns, on January 31, 2019, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a highly anticipated, 123-page...more

Baker Donelson

Medicaid Forecast: Slower Enrollment Growth and Higher Spending Growth for FY 2017 – 2018: Results from a 50-State Medicaid Budget...

Baker Donelson on

On October 19, Kaiser Family Foundation and Health Management Associates hosted a joint briefing to release their 17th Annual 50-State Medicaid Budget Survey for state fiscal years (FY) 2017 and 2018. The survey highlights...more

Akerman LLP - Health Law Rx

Issues and Analysis of the State’s Medicaid Managed Assistance ITN

The recently released Invitations to Negotiate (ITN) for Florida’s Statewide Medicaid Managed Care program (SMMC) parallels in large part the State’s initial procurements that were released in 2012 and 2013. Where the current...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: Monthly Expansion Recap - April 2017

Emerging News on Expansion - Congress Restarts Debate on the AHCA, Which Would Significantly Cut Medicaid Funding and Coverage - House Republicans have revived the debate over the AHCA, and are discussing a potential...more

Manatt, Phelps & Phillips, LLP

Medicaid Coverage of Social Interventions: A Roadmap for States

Editor's Note: Faced with mounting evidence about the impact of social factors—such as income, access to food and housing, and employment status—on health outcomes, Medicaid agencies are looking for ways to integrate social...more

McCarter & English, LLP

Health Law Insights Newsletter - Issue 8 - April 2016

McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more

Sheppard Mullin Richter & Hampton LLP

States Take Aim At Health Insurance Providers Fee In New Litigation

Three states—Kansas, Louisiana and Texas—filed a complaint in federal court on October 22, 2015 challenging the constitutionality and legality of the Affordable Care Act’s health insurance providers fee. The health...more

King & Spalding

CMS Proposes Sweeping Changes to Medicare Reimbursement for Clinical Diagnostic Laboratory Tests

King & Spalding on

First Data Collection Period for Clinical Laboratories Is July 1, 2015 to December 31, 2015 - In the October 1, 2015 Federal Register, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule...more

Manatt, Phelps & Phillips, LLP

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

Arkansas's “Private Option” is projected to have a net impact of $438 million on state funds 2017-2021; Iowa selects MCOs for proposed Medicaid managed care transition; and, the DC Marketplace launches a robust dual-language...more

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