News & Analysis as of

Healthcare Fee-for-Service

Manatt, Phelps & Phillips, LLP

CMS Releases Technical Guidance to States on Complying with Medicaid Access Final Rule

On July 12, CMS released a companion guide to the Ensuring Access to Medicaid Services final rule (the “Access Final Rule”). This technical guidance—which focuses on the provisions regarding fee-for-service (FFS) payment...more

Manatt, Phelps & Phillips, LLP

Senate Finance Explores Medicare Physician Payment and Graduate Medical Education Reform

On May 17, the Senate Finance Committee released a long-awaited white paper describing its legislative effort focused on bolstering chronic care through physician payment. Following a committee hearing April 11, the white...more

Nelson Mullins Riley & Scarborough LLP

Using A Value-Based Enterprise to Integrate Specialists and Primary Care: Taking Value-Based Care to the Next Level

Meaningful progress has been made in value-based care, but the documented advances in reducing costs and improving patient outcomes have taken place predominately in the primary care sector. Significantly less headway has...more

Foley & Lardner LLP

Medicaid: CMS Final Rules Aim to Expand Access, Provide Parity with Commercial Markets

Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (CMS) published two significant updates to its Medicaid regulations on May 10, 2024. The two Final Rules, a Medicaid Access Rule and a Medicaid Managed Care Rule, impose new...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

Hall Benefits Law

Health Care Stakeholders Support Passage of The Value in Health Care Act

Hall Benefits Law on

Seventeen healthcare stakeholder groups have come together to support The Value in Health Care Act, a bill that a bipartisan coalition reintroduced in Congress this summer. The bill supports a shift in the medical care...more

Epstein Becker & Green

Rare DOJ Criminal Indictment Related to Medicare Advantage Risk Adjustment

Epstein Becker & Green on

In an indictment announced on October 26, 2023 in Miami, the U.S. Department of Justice, Criminal Division’s Fraud Section, working with the FBI and HHS-OIG, brought what may be only the second federal criminal charges...more

Dickinson Wright

Value-Based Care Ushers in a New Era for Primary Care Providers

Dickinson Wright on

Originally published in Healthcare Michigan, Volume 40,  No. 10 - In an age of highly polarized opinions, there is a common consensus to address the rapidly rising health care costs in the United States. Research shows that...more

Proskauer - Minding Your Business

States and Healthcare Leaders Must Respond to New Health Equity Regulations

This year, the federal government’s new health equity regulations began taking effect. The regulations represent the government’s increased commitment to health equity advancement as a major part of its regulatory...more

McDermott Will & Emery

Top Takeaways | 2023 Value-Based Care Symposium | Health System Innovation in Value-Based Care

McDermott Will & Emery on

In this session, panelists focused on the unique challenges and opportunities facing health systems as they move into value-based care (VBC)...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

McDermott Will & Emery

HHS OIG Develops Toolkit to Analyze Telehealth Claims to Assess Program Integrity Risks

McDermott Will & Emery on

On April 20, 2023, the United States Department of Health and Human Services Office of the Inspector General (HHS OIG) released a new toolkit designed to help analyze telehealth claims to assess federal healthcare program...more

Foley & Lardner LLP

Payor/Provider Convergence and What It Means for You

Foley & Lardner LLP on

Welcome to the Payor/Provider Convergence Series of the Health Care Law Today blog. This series is dedicated to exploring the intersection between payors and providers in the health care space; in particular, the evolving...more

Nelson Mullins Riley & Scarborough LLP

Price Transparency – CMS Updates Enforcement Process

As many are aware, compliance with price transparency requirements continues to lag. Under the final rule, effective January 1, 2021, hospitals are required to provide clear, accessible pricing information online about the...more

Groom Law Group, Chartered

CMS Medicare Advantage RADV Final Rule: No Fee-For-Service Adjuster, May Extrapolate Audit Findings Beginning with PY 2018

More than four years after it was proposed, on February 1, 2023 the Centers for Medicare & Medicaid Services (CMS) published the long-awaited risk adjustment data validation (RADV) Final Rule (Final Rule) that will affect...more

King & Spalding

CMS Proposes Rule to Require Certain Health Plans to Electronically Share Data with Providers Regarding Prior Authorization...

King & Spalding on

On December 13, 2022, CMS is set to publish in the Federal Register a proposed rule (Proposed Rule) requiring certain Medicare, Medicaid, Children’s Health Insurance Program, and Qualified Health Plan fee-for-service and...more

Polsinelli

Minimum Wage Increase for Employees of Florida Medicaid Providers

Polsinelli on

On June 2, 2022, Governor DeSantis signed the “Freedom First Budget” for Fiscal Year 2022-2023 for the sole purpose of increasing the minimum wage for employees and independent contractors of Medicaid providers to at least...more

Proskauer - Health Care Law Brief

The Supreme Court Denies Petition Challenging CMS’s Overpayment Rule

This past week, the Supreme Court of the United States (Supreme Court) denied UnitedHealthcare Insurance Company’s (UnitedHealthcare) petition for a writ of certiorari (Petition) challenging, in part, the Centers for Medicare...more

Proskauer - Health Care Law Brief

CMS Responds to Industry Stakeholder Feedback, Redesigns and Renames the GPDC Model for DCEs as the ACO REACH Model

On February 24, 2022, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), announced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH)...more

Manatt, Phelps & Phillips, LLP

CMS Solicits Input on Potential Medicaid and CHIP Reforms Around Eligibility, Enrollment and Access

On February 17, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI) regarding the federal standards that govern access to care in Medicaid and the Children’s Health Insurance Program...more

Sheppard Mullin Richter & Hampton LLP

Day Four Notes for the 40th Annual J.P. Morgan Healthcare Conference, 2022

Thursday, January 13 was the last day of the virtual J.P. Morgan Annual Healthcare Conference for 2022. And since the conference was virtual, what better topic to start us off today than a consideration of the new...more

Sheppard Mullin Richter & Hampton LLP

CMS to the Rescue for MA and Part D Plans – Rate Announcement Includes Significant Increase in Plan Payments for 2022

Over the last year, we have seen volatility in the healthcare industry overall, and Medicare Advantage (“MA”) and Medicare Part D plans (together, “Plans”) have not been immune. Particularly because of their risk adjustment...more

Sheppard Mullin Richter & Hampton LLP

Global and Professional Options Direct Contracting Model RFA and LOI Now Active

On April 21, 2019, the Center for Medicare and Medicaid Innovation (“CMMI”) announced the CMS Primary Cares Initiative – a voluntary, risk-based initiative to transform the Medicare program’s reimbursement of primary care...more

Foley Hoag LLP - Medicaid and the Law

CMS Medicaid Fiscal Accountability Regulation Published

Earlier this week, CMS released for publication a proposed rule that would add some degree of transparency and oversight to the somewhat opaque world of Medicaid financing. It’s a topic that’s fascinated us here at the...more

Polsinelli

Making Sense of the MACRA Final Rule, Part 1 of 3: Essential Concepts

Polsinelli on

On Oct. 14, the Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The nearly 2,400 pages of...more

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