News & Analysis as of

Healthcare Reform

Quarles & Brady LLP

Arkansas Law Prohibits Pharmacy Benefit Managers from Obtaining or Holding Pharmacy Permits

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On April 16, 2025, Arkansas House Bill 1150 (the “Bill”) was signed by Governor Huckabee Sanders. The Bill will have substantial implications for pharmacy benefit managers (“PBMs”) and pharmacies across the country....more

Dentons

Iowa 2025 Legislative Session – Week 14

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Last week, the energy changed under the golden dome as legislators gave the first indications they are moving towards ending this year’s legislative session. While ultimately not taken up by either chamber this week, Pharmacy...more

Alston & Bird

Health Care Week in Review | President Trump Announces Actions to Lower Drug Prices; Trump Administration Initiates Section 232...

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

Ballard Spahr LLP

Section 1557: Deadlines Approach, But Long-Term Prognosis Unclear Under Executive Orders

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Section 1557 of the Affordable Care Act mandates nondiscrimination in health care programs managed or funded by the Department of Health and Human Services (HHS), with upcoming deadlines for compliance set for May and July...more

Sheppard Mullin Richter & Hampton LLP

CMS Issues CY 2026 Medicare Advantage and Part D Final Rule

On April 4, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the contract year (“CY”) 2026 final rule for the Medicare Advantage (“MA”) program, Medicare Prescription Drug Benefit Program (“Part D”),...more

Cozen O'Connor

Democratic AGs Mount Fevered Challenge to Proposed Rule Impacting Affordable Care Act

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A group of 22 Democratic AGs submitted comments opposing the Centers for Medicare and Medicaid Services’s (CMS) Proposed Rule, which would change enrollment, eligibility, and coverage under the Patient Protection and...more

Spilman Thomas & Battle, PLLC

The Dome Report: Final Review of the 2025 Regular Session of the West Virginia Legislature

The 2025 regular session of the West Virginia Legislature concluded at midnight on April 12. As the dust settled, it became clear that Governor Patrick Morrisey was able to get the majority of his agenda enacted into law,...more

Benesch

Dialysis & Nephrology Digest - April 2025

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ESRD ETC among value-based care models being ended early by CMS - This decision to end the ESRD ETC payment model and several others on Dec. 31 aligns with CMS’ goal to focus on models that demonstrate potential for...more

Sheppard Mullin Richter & Hampton LLP

CMS to Withdraw Federal Medicaid Match for Workforce, Social Needs, and Infrastructure: What States, Health Care Providers and...

In a move signaling a major shift in federal priorities, the Centers for Medicare & Medicaid Services (“CMS”) recently announced it will limit federal funding for state Medicaid initiatives that support services beyond direct...more

McDermott+

Inpatient Prospective Payment System (IPPS) Data Dashboard

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Updated to include Medicare claims data thru Q3 2024. What is the cost of a knee implant in the inpatient setting? How much does Medicare pay for different types of cardiac valve procedures? How have Medicare inpatient...more

McDermott+

FY 2026 Proposed Rules Are Out! Overview of the IPPS Proposed Rule

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Last Friday, the Centers for Medicare & Medicaid Services (CMS) officially launched the health policy community into reg season, releasing in one fell swoop all the fiscal year (FY) 2026 Medicare proposed regulations for...more

McDermott Will & Emery

Beyond Private Equity Transaction Oversight: Mass. H.5159 Includes New Licensing Requirements

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H.5159, An Act Enhancing the Market Review Process, was signed into law in January 2025. The primary focus of H.5159 is to expand the Commonwealth’s healthcare oversight mechanisms, particularly with respect to private equity...more

Jones Day

CMS Innovation Center Announces Cost-Saving Restructuring of Value-Based Payment Model Portfolio

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The Center for Medicare and Medicaid Services ("CMS") has announced significant changes to its value-based payment model portfolio projected to save $750 million as part of a shift in the agency's refocused strategy toward...more

Goldberg Segalla

Gov. Hochul’s Proposed Regulatory Changes to Workers’ Comp Treatment

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In her 2025 State of the State, Gov. Kathy Hochul outlined several proposals aimed at improving access to medical care within the New York State Workers’ Compensation system. These initiatives, detailed in her “Fighting for...more

Snell & Wilmer

Proposed Senate Bill in California Would Strengthen Restrictions on Hedge Fund and Private Equity Investments in Healthcare

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On February 12, 2025, Senator Christopher Cabaldon introduced Senate Bill 351 (“SB 351” or “the bill”), to strengthen and codify the corporate practice of medicine doctrine (CPOM) in California as it relates to private equity...more

Epstein Becker & Green

CMS Tells States “No More” Medicaid Section 1115 Matching Funds for Designated State Health Programs (DSHP) and Designated State...

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In recent years, the Centers for Medicare & Medicaid Services (CMS) has approved demonstrations under Section 1115 of the Social Security Act, providing federal matching funds for state expenditures for Designated State...more

DLA Piper

Keeping Watch on the Inflation Reduction Act: Medicare Poses Part D Formulary Access Challenges

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Key points include access to medicines in medicare is reduced as the IRA is implemented; fewer drugs are covered on Medicare Part D formularies in 2025 relative to 2024; medicines for serious conditions with high unmet needs...more

McDermott Will & Emery

CMS Updates SNF Attachment Guidance Ahead of May 1 Enrollment Deadline

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Skilled nursing facilities (SNFs) historically have been required to disclose ownership and managerial control information as part of their Medicare enrollment. However, these requirements were significantly expanded to...more

Mintz - Health Care Viewpoints

HHS Restructuring and Workforce Reductions – Key Implications for the Health Care Industry

As spring arrived in the mid-Atlantic region, the Department of Health and Human Services (HHS) under Robert F. Kennedy, Jr. followed through with a previously announced Reduction in Force (RIF) that reduced the department’s...more

Morris, Manning & Martin, LLP

One Big Thought – Charting a Human-Centered Future in the Age of Artificial Intelligence: Part Five

One of the most profound concerns about the rise of artificial intelligence is the potential erosion of authentic human interaction. The convenience of digital platforms and virtual assistants, while liberating in many ways,...more

Alston & Bird

Health Care Week in Review | House and Senate Agree to Budget Resolution; CMS Releases Inpatient and Post-Acute Payment Proposed...

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

McDermott+

McDermott+ Check-Up: April 11, 2025

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THIS WEEK’S DOSE - House Passes Concurrent Budget Resolution for Reconciliation Process. Passage of the resolution didn’t resolve the policy differences between the House and the Senate. Those still need to be addressed as...more

Bass, Berry & Sims PLC

Wall Street and Industry React Favorably to CMS Medicare Advantage Rate Increase & Final Part C and D Rule for 2026

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Two recent announcements from the Centers for Medicare & Medicaid Services (CMS) offer early indicators as to how the Trump administration, including CMS administrator Dr. Mehmet Oz, may approach the Medicare Advantage (MA)...more

Husch Blackwell LLP

Massachusetts Codifies ‘Shield Law' Protections for Physicians

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On April 9, 2025, emergency amendments filed by the Massachusetts Board of Registration in Medicine (BORIM) became final, enshrining protections for Massachusetts’ providers for the delivery of reproductive healthcare...more

Maynard Nexsen

NAIC Spring Meeting Update Part Two

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As discussed in last week’s article, along with almost 3,000 regulators and insurance industry leaders, the Maynard Nexsen Insurance Regulatory team of attorneys attended the National Association of Insurance Commissioners...more

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