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Medicaid › Medicaid Reimbursements

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 -
Foley & Lardner LLP

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

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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

Harris Beach PLLC

New York Issues Technical Specifications Manual that Addresses Medicaid Payment Reporting

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The New York Department of Health (DOH) announced March 8 that the 2022-2023 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual is available....more

Rivkin Radler LLP

Behavioral Health Provider Ordered to Repay $1.1 Million to NJ Medicaid Program

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An audit by the New Jersey Office of the State Comptroller (OSC) found that John Gore, a licensed drug and alcohol counselor, improperly billed and received over $1 million in Medicaid payments for services provided between...more

Akerman LLP - Health Law Rx

Fix Your Weak Links in Your Medicaid Claims

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Medicaid providers and suppliers have likely discovered this the hard way. A provider’s or supplier’s enrollment in the Medicaid program may be insufficient to assure that their provision of a covered and medically necessary...more

Holland & Knight LLP

Supreme Court Expands States' Ability to Recoup Future Medicaid Costs from Tort Recoveries

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The U.S. Supreme Court interpreted the Medicaid Act on June 6, 2022, to permit state Medicaid programs to recover costs for future medical care that has not yet been provided and may never be provided from Medicaid...more

Epstein Becker & Green

[Webinar] The Future of CMS: A Conversation with Three Former CMS Administrators - July 15th, 12:00 pm - 1:00 pm ET

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Epstein Becker Green invites you to join former CMS Administrators Tom Scully, Leslie Norwalk, and Marilyn Tavenner for a unique panel discussion on their thoughts, advice, and predictions for President Biden’s newly...more

Chambliss, Bahner & Stophel, P.C.

Tennessee General Assembly Significantly Expands Telehealth Flexibility and Payment Parity

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Yesterday (August 13), while in special session ordered by Gov. Bill Lee, the Tennessee General Assembly overwhelmingly passed an amended version of HB8002, which significantly enhances telehealth flexibility and payment...more

Greenbaum, Rowe, Smith & Davis LLP

HHS Issues Stimulus Payments Under CARES Act to Eligible Providers

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The U.S. Department of Health and Human Services (HHS) has begun the release of $30 billion of the $100 billion Public Health and Social Services Emergency Fund that is part of the Coronavirus Aid, Relief, and Economic...more

Akerman LLP - Health Law Rx

Texas Telemedicine Updates

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As with other states, in response to the COVID-19 pandemic and the guidance that the federal government has issued, Governor Abbott of Texas issued a disaster declaration on March 13, 2020 (the Disaster Declaration) resulting...more

Foley & Lardner LLP

FQHCs: The Nuts and Bolts of Medicaid Reimbursement

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This is the second article in our series addressing important topics for federally qualified health centers (FQHC) and the providers who work with them. Our first post in the series offered five tips for contracting with...more

Baker Donelson

D.C. District Court Issues Two Decisions Addressing CMS's Medicare Bad Debt "Must Bill" Policy – One Rejecting the Policy and the...

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In a significant break from preceding court decisions, the United States District Court for the District of Columbia recently struck down CMS's "must bill" policy, which requires that Medicare providers bill Medicaid and...more

Shumaker, Loop & Kendrick, LLP

Client Alert: Florida Medicaid Behavior Analysis Services Providers must obtain a Health Care Clinic License or Exemption...

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The Florida Agency for Healthcare Administration (“AHCA”) has added a condition of Medicaid enroll­ment for behavior analysis services. Behavior analysis providers use applied behavior analysis to assist children with autism...more

Mintz - Health Care Viewpoints

ML Strategies Update - The IMPROVE Act Summary

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Yesterday (December 11, 2018), the House passed H.R. 7217, the Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act. The Senate is expected to vote on the IMPROVE Act sometime next week. A...more

Bricker Graydon LLP

OIG report finds Ohio Department of Medicaid made payments for deceased

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A recent report issued by the U.S. Department of Health & Human Services, Office of Inspector General (OIG), entitled “Ohio Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries’ Deaths,” found...more

Mintz - Health Care Viewpoints

Texas: A Cautionary Tale for Medicaid Management and Managed Care Companies

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State Medicaid Agencies have historically engaged in an epic balancing act. Federal law requires State Medicaid Agencies to ensure beneficiaries have access to medically necessary services. Federal law also requires State...more

Sheppard Mullin Richter & Hampton LLP

In Case Alleging Nationwide Pharmacy Fraud, Kmart Scores Narrow Settlement

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As described in an April 17, 2018 article originally posted on the Sheppard Mullin Richter and Hampton, LLP False Claims Act Defense Blog, Kmart Corporation and the U.S. Department of Justice entered into a False Claims Act...more

K&L Gates LLP

K&L Gates Triage: 340B Update: State Medicaid 340B Billing Requirements

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In the midst of the ongoing federal conversation surrounding the 340B Drug Pricing Program, individual states are implementing a number of regulatory efforts related to the 340B Program at an increasingly fast pace. These...more

Foley & Lardner LLP

Ninth Circuit Victory Opens the Door to Medicaid Reimbursement Challenges Based on Equal Access Requirement

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The Ninth Circuit held August 7 that the Department of Health and Human Services Secretary erred in approving a Medicaid State Plan Amendment (SPA) that cut reimbursement for outpatient hospital services in California by 10%...more

Perkins Coie

Ninth Circuit Raises Bar for Approving Changes in State Medicaid Reimbursement

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The U.S. Court of Appeals for the Ninth Circuit Court raised the bar last week for what states must prove to establish that their Medicaid provider reimbursement rates are sufficient to ensure a robust network of providers...more

Hogan Lovells

"Double Dip" Effectively Approved by Center for Medicare and Medicaid Services

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Last week the Centers for Medicare and Medicaid Services (CMS) issued Release No. 104 to Manufacturers and Release No. 180, which invalidated earlier agency releases addressing the treatment under the Medicaid drug rebate...more

Manatt, Phelps & Phillips, LLP

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

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HealthCare.gov plans an open enrollment pilot that will let consumers compare provider network breadth; new Medicaid enrollees reduce out-of-pocket spending on prescription drugs by nearly 60%; and Kansas’s Governor announces...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: CMS Revises Process for Determining MMC Payments

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In its April 25, 2016 Medicaid managed care final rule, the Centers for Medicare and Medicaid Services (CMS) provides a revised framework for determining how managed care plans should be paid by state Medicaid programs. A...more

Polsinelli

Coming Soon to a Hospital near You: Mandatory Bundled Payments for Common Surgeries

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Recent action by the Centers for Medicare and Medicaid Services (CMS) announces significant change in reimbursement methodology for high volume orthopedic surgical procedures in many markets nationwide. Affected stakeholders...more

Holland & Knight LLP

HHS Issues Proposed 340B Program Omnibus Guidance: Five Things to Watch

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The 340B Drug Pricing Program (340B Program), established by Section 602 of the Veterans Health Care Act of 1992, is administered by the Health Resources and Services Administration (HRSA) of HHS. The 340B Program requires...more

Manatt, Phelps & Phillips, LLP

Health Update - September 2015

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Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

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