News & Analysis as of

Medi-Cal

Changes to California’s Document Retention Policy

by King & Spalding on

Medi-Cal and other California health care providers will soon be required to change their document retention policies and practices for services rendered under programs administered by California’s Department of Health Care...more

Establishing a Medicaid Per Capita Cap: Implications for California - Presentation

Both the House-passed American Health Care Act (AHCA) and the Senate’s draft Better Care Reconciliation Act (BCRA) of 2017 propose major changes to Medicaid’s financing structure. These include caps on federal funding for...more

Medicaid Edition: Establishing a Medicaid Per Capita Cap: Implications for California

Both the House-passed American Health Care Act (AHCA) and the Senate’s draft Better Care Reconciliation Act (BCRA) of 2017 propose major changes to Medicaid’s financing structure. These include caps on federal funding for...more

California Court Upholds Expansive Definition of Recoupment

The Bankruptcy Court for the Central District of California examined the scope of the doctrine of recoupment for Medicaid and related payments, allowing the deduction by the state. The court held that the California...more

California’s $20B Problem: Obamacare Repeal Threatens 4M Californians

The repeal of the Affordable Care Act (ACA) could ultimately cost California as much as $20 billion in annual federal spending on the state’s Medicaid program, Medi-Cal. Putting this in perspective, $20 billion represents...more

California Clamps Down On Surprise Out-Of-Network Bills

by Buchalter on

On September 23, 2016, Governor Brown signed AB 72, California’s surprise out-of-network law. The bill protects patients who seek care at an in-network facility from balance billing by individual health care providers who are...more

California Targets Surprise Medical Bills, Follows on the Heels of New York and Florida

by Foley & Lardner LLP on

Governor Brown approved a new law last Friday that limits patient exposure to so-called surprise medical bills. AB 72 caps the cost-sharing obligations of patients who unexpectedly receive care from non-contracted providers...more

California Ballot 2016: Pros and Cons of Props 51-56

by Lewitt Hackman on

Californians must decide on 17 initiatives in the November election this year, and those are just the proposed measures of state-wide concern. Never mind the many local initiatives affecting counties and neighborhoods. The...more

Manatt on Health Reform: Weekly Highlights - August 2016 #3

CMS’s risk adjustment program data signals an improving risk pool while the agency announces plans to modify the program; California enrolls 134,000 undocumented immigrant children into Medicaid; and Oregon approves increases...more

Manatt on Health Reform: Weekly Highlights - August 2016

Oregon’s hospitals see improved financial performance following the ACA; CMS denies Indiana’s request for an additional lockout period in the Medicaid expansion program; and a new Manatt Health report details Medicaid funding...more

Manatt on Health Reform: Weekly Highlights - July 2016 #3

Massachusetts’s Marketplace eliminates cost-sharing for addiction treatment in subsidized QHPs; Montana cuts its uninsurance rate in half; and a Kaiser report identifies the 50 most costly drugs for Medicaid....more

Manatt on Health Reform: Weekly Highlights - June 2016 #5

Kentucky proposes premium assistance and high deductible health plans to cover expansion enrollees under an 1115 waiver; New York Legislature expresses unanimous support for a reimbursement increase for safety-net hospitals;...more

For Golden State, a $1 Billion Tab from Big Pharma to Treat One Disease

Californians have gotten an unpleasant taste of the policy complexities caused when Big Pharma sets sky-high prices for life-changing drugs: State health officials say they need to set aside $1 billion to pay for increasing...more

Health Update - June 2016

Real-Time Data Analytics in Government Investigations and Reducing Exposure - It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more

Moving Medi-Cal Forward: The Path to Delivery System Transformation

Over the past few years, California’s Medicaid program, known as Medi-Cal, has been catapulted into a new role. It has evolved from a program designed to provide health coverage to a subset of low-income individuals and help...more

Manatt on Health Reform: Weekly Highlights - May 2016 #4

Uninsurance hit a record-breaking low of 9.1% in 2015; Vermont legislators pass a bill to increase drug formulary and price transparency; and California rolls out its State-funded Medi-Cal expansion to undocumented children....more

Healthcare Claim Administrator’s Authorization of Services While Failing to Disclose Alcohol-Related Exclusion Supports Action for...

In Tenet Healthsystem Desert v. Blue Cross of California (No. D069057, filed 3/17/16), a California Court of Appeal held that a hospital was not limited to simply collecting on its bills, but could state causes of action...more

Manatt on Medicaid: CMS Approves California's Delivery System Reform Incentive Payment (DSRIP) Waiver Renewal

On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved California's request to renew its waiver under Section 1115 of the Social Security Act. A significant component of the waiver is the Delivery...more

CMS Grants California’s Request for Five-Year Medicaid Waiver

by King & Spalding on

On December 30, 2015, CMS approved California’s request for a five-year waiver to extend California’s Section 1115(a) demonstration project, entitled “California Medi-Cal 2020 Demonstration.” According to the CMS approval...more

CMS Approves California’s Section 1115 Medicaid Demonstration

by Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) has approved a new section 1115 Medicaid demonstration for the state of California. Under the demonstration, the California Department of Health Care Services (DHCS) will...more

CMS approves $25 billion California Medi-Cal 2020 Demonstration Project

by Dentons on

On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved a new Section 1115 Demonstration Project for California which could total $24.8 billion over a five year period to serve the uninsured and...more

Manatt on Health Reform: Weekly Highlights - November 2015

Montana receives approval to expand Medicaid beginning 2016; California’s $6.2 billion Medicaid waiver receives pre-approval; and HHS proposes broadening circumstances under which states receive enhanced federal matching...more

CMS Prevails in Dual Eligible Bad Debt Challenge

by Baker Ober Health Law on

In a decision handed down on August 7, 2015, the United States Court of Appeals for the District of Columbia Circuit upheld the denial of the providers' bad debt claims associated with dual eligible beneficiaries. Grossmont...more

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

This week...no clear consensus has emerged among congressional Republicans on how to manage potential King v. Burwell fallout; California will expand Medicaid to undocumented children; and New York is poised to become the...more

Supreme Court Rules That Providers and Suppliers Cannot Challenge Medicaid Reimbursement Rates in Federal Court

by Epstein Becker & Green on

On March 31, 2015, a 5-4 plurality of the Supreme Court of the United States ruled that Medicaid providers do not have a private right of action under the Medicaid statute to challenge reimbursement rates. The Supreme Court’s...more

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