News & Analysis as of

Medicaid

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -

OIG Work Plan – October 2017 Update

by Baker Ober Health Law on

The OIG added five new items to its Work Plan with its October 2017 monthly update. This is a decrease from the nine new items added to the Work Plan with the September 2017 update. (For more information on last month's Work...more

Worth Another Look: The Human Services Code

The first and only “code bill” to reach the Governor’s desk this fiscal year is H.B. 59 (Moul, R-Adams), the Human Services Code bill. Although the Governor has until October 28 to sign the bill into law, he previously stated...more

Corporate Actors Held Individually Accountable in Recent False Claims Act Settlement

The Department of Justice (“DOJ”) has sent a clear message that individuals cannot hide behind the corporate shield in its recent settlement with Med-Fast Pharmacy, Inc. and the charges brought against its associated...more

Blog: OIG Releases October Work Plan Items; Includes Opioid REMS and Specialty Drug Coverage and Medicare Reimbursement

by Cooley LLP on

As we recently announced, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The October updates include 5 new Work Plan items...more

Disproportionate Share Hospital Payments: A Minibus Rider

As a part of our ongoing blog series we have provided details on the structure, funding, and outlook of several expiring health care provisions, that we’ve referred to as the health care minibus. The minibus includes all of...more

Texas Continues to Embrace Telemedicine

by McDermott Will & Emery on

On September 15, 2017, the Texas Medical Board (Board) released proposed rules regarding telemedicine and mental health services (Proposed Rules) to implement Senate Bill 1107, which was passed on May 11, 2017. Most notably,...more

CHIP Reauthorization Legislation and Medicare-Medicaid Extender Provisions

by Holland & Knight LLP on

In this memorandum, Holland & Knight's Healthcare & Life Sciences Team summarizes recent legislative action on funding for the Children's Health Insurance Program (CHIP). The Senate Finance Committee and the House Energy...more

Trump Administration Shelves Additional Obama Medicare/Health Plan Proposals

by Reed Smith on

The Trump Administration has formally withdrawn a number of pending Department of Health and Human Services (HHS) proposals that never reached the final rule stage. This includes: a controversial Part Medicare B drug payment...more

Capitol Hill Healthcare Update

by BakerHostetler on

Although the Children’s Health Insurance Program (CHIP) enjoys broad bipartisan support on Capitol Hill, lawmakers last week sharply disagreed over how to pay for its renewal – signaling that a final vote could be delayed for...more

CMMI Requests Ideas to Spur Innovation and Reduce Burden

by Polsinelli on

The Center for Medicare & Medicaid Innovation (CMMI) is seeking ideas on how to better drive change and reduce regulatory burden. CMMI solicited ideas to shape the agency’s future activities through a September 2017 “request...more

Value-Based Contracting for Prescription Drugs and Medical Devices: An Innovative Solution Impaired by Outdated Regulations

by Pepper Hamilton LLP on

Often lost in the cacophony of headlines surrounding rising health care costs is the promise that value-based contracting offers as a possible solution. In contrast to the traditional fee-for-service model, value-based...more

CMS Unexpectedly Withdraws Three Proposed Rules

The Centers for Medicare and Medicaid Services (CMS) recently announced the withdrawal of three proposed rules that, in one case, had been pending since 2014. The first proposed rule that CMS decided to scrap was proposed in...more

HHS-OIG blesses product replacement program

by Dentons on

The federal health care program anti-kickback statute, 42 U.S.C. § 1320a-7b(b) (AKS), in addition to prohibiting payments for patient referrals, prohibits one party (such as a manufacturer) from providing anything of value to...more

Focus on Health Care Provider Bankruptcies

by Jones Day on

The next few years are expected to see a significant increase in the volume of bankruptcy cases filed by health care providers. Thus far in 2017, the number of bankruptcies in health care-related sectors, including hospitals,...more

Public Health Emergencies and Mother Nature

by Farrell Fritz, P.C. on

In the wake of some of the worst storms our Country has ever faced, as seen in the devastation caused by Hurricane Harvey, in Texas, Hurricane Irma, in Florida, and now Hurricane Maria, in Puerto Rico and the U.S. Virgin...more

This Month in Corruption: Improper Billing, Double Dipping, Disability Faking

by PretiFlaherty on

A Dream Most Improper. On September 4, announcements came from the offices of the U.S. Attorney for Massachusetts and the Massachusetts Attorney General that Dental Dreams, a national dental chain with locations in...more

Lending Against Medicare/Medicaid Receivables: A Refresher Course

by Burns & Levinson LLP on

With the failed effort to overturn the Patient Protection and Affordable Care Act (a/k/a Obamacare) this week, the expansion of Medicaid coverage in effect since that law’s passage will be around for a while. The bill to...more

Disproportionate Share Hospitals Facing Steep Payment Cuts

While September 30, 2017 has been an important procedural deadline for purposes of the GOP’s most recent legislative push to repeal the Affordable Care Act (ACA), it also serves a critical funding deadline for purposes of the...more

Ninth Circuit Denies Arbitration in a False Claims Act Case

On September 11, 2017, the Ninth Circuit in US and State of Nevada ex rel. Welch v. My Left Foot Children’s Therapy, LLC, upheld the denial of the defendant’s motion to compel arbitration in a False Claims Act (FCA) relator...more

CMS Seeks New Direction for Center for Medicare and Medicaid Innovation

by King & Spalding on

On September 20, 2017, the Center for Medicare and Medicaid Innovation (“CMMI”) issued an informal Request for Information (“RFI”) seeking public feedback on “a new direction to promote patient-centered care and test...more

OIG Work Plan – September 2017 Update

by Baker Ober Health Law on

Beginning in June 2017, the OIG began making monthly Work Plan updates. These monthly updates create some practical challenges for health care providers and compliance professionals trying to make operational and compliance...more

The After-Effects of Graham-Cassidy’s Demise

by Epstein Becker & Green on

The proposed legislation known as Graham-Cassidy, the latest Republican proposal to repeal and replace the Affordable Care Act (ACA) and restructure federal Medicaid financing, will not be put to a vote because 51...more

Senate GOP Abandons Last-Ditch ACA Repeal/Replace Legislation in Face of Opposition

by Reed Smith on

The latest Republican Congressional attempt to repeal and replace the Affordable Care Act (ACA) has foundered, as three Republican senators announced they will join Democratic senators in opposing the “Graham-Cassidy” repeal...more

Summary of Anticipated Major Changes to the Organization and Delivery of Certain Medicaid (Medical Assistance) Benefits in...

by Tucker Arensberg, P.C. on

Managed Long Term Supports and Services - Pennsylvania is undertaking several major changes to the organization and delivery of certain Medicaid (Medical Assistance) benefits in Pennsylvania through Community Health...more

Fractal Geometry, Actuarial Risk, and §1332 Waivers—The Role of the States in Reforming Health Care

At this writing, the prospects for success of the latest Republican effort to replace the Affordable Care Act appear bleak — but the Graham-Cassidy bill on which the GOP has pinned its last-ditch hopes highlights a major...more

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