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 -

Memo to Massachusetts Employers for 2018 and 2019: How Not to Comply with the EMAC New Rules

In a November 20, 2017 post, we reported on Massachusetts’ passage of H. 3822, “An Act Further Regulating Employer Contributions to Health Care,” (the “Act”), the purpose of which is to shore up the finances of the...more

Manatt on Health: North Carolina: Amended 1115 Waiver Application

On November 20, 2017, North Carolina submitted an amended 1115 waiver application to the Centers for Medicare & Medicaid Services (CMS) seeking authority to invest $1.2 billion over five years in a range of targeted...more

Telehealth Opportunities Worth Watching in 2018

by Pullman & Comley, LLC on

Continued physician shortages, reduced reimbursement from government and private insurance plans and the ever-increasing health care needs of an aging population are forcing payors and providers alike to increase the...more

Medicaid Expansion May Reduce Medical Divorce Rates

Medical divorce is a term coined some years ago to describe a divorce obtained for medical reasons. More specifically, according to an article by George Diepenbrock, researchers defined “medical divorce” as “an instance where...more

What's New In Washington - December 2017

December is often the busiest time in Washington, and this year is no different as Congress races toward the holiday finish line. There is still a multitude of problems to solve before members can head back to their...more

Health Care Weekly Preview from ML Strategies – December 2017 #2

This week, Republican efforts to pass a tax reform package is likely to come to a head with the clock running out on 2017. The Conference Committee will meet on Wednesday in hopes of putting the finishing touches on a bill...more

Strengthening Medicaid Long-Term Services and Supports in an Evolving Policy Environment: A Toolkit for States

Low-income adults who need and use long-term services and supports (LTSS) are among the most complex, expensive, and fast-growing populations covered by Medicaid. The challenges of organizing and paying for this much needed...more

Recent Congressional Actions Bring Drug Pricing Debate Back Into National Spotlight

by Holland & Knight LLP on

In late October, Sen. Bernie Sanders (I-VT) and Rep. Elijah Cummings (D-MD) introduced the Medicare Drug Price Negotiation Act of 2017 (S. 2011; H.R. 4138), which would allow the Department of Health and Human Services (HHS)...more

CMS Waives Medicaid Retroactive Eligibility For Iowa: Is Your State Next?

by Cozen O'Connor on

Since 1973, the Social Security Act has mandated that states provide retroactive Medicaid benefits for three months prior to the individual’s application. SSA § 1902(a)(34). Congress enacted this provision to provide...more

OIG November 2017 Work Plan Update

by Baker Ober Health Law on

The OIG added four items to its Work Plan with the November 2017 update, as listed on the chart below. Interestingly, three of the four new items relate to Medicaid. Hot topics include prescriptions for extreme amounts of...more

Another Obstacle to Medicare and Medicaid Compliance

by McGuireWoods LLP on

When investigating whether an individual or entity is excluded from the federal healthcare programs, healthcare organizations must be on the alert for yet another method for defrauding the government: alias names. Alias names...more

Manatt on Health: Medicaid Edition: CMS Administrator Highlights Medicaid Policy Goals and New Guidance

Since assuming office last January, the Trump administration has signaled a shift in Medicaid policy. In early November, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma made the administration’s...more

Williams Mullen On Call - November 2017

by Williams Mullen on

Welcome to the third edition of Williams Mullen On Call. In this edition, we are pleased to provide two very timely interviews. The first interview is with Mandy K. Cohen, MD, MPH, Secretary of the North Carolina Department...more

New CMS Guidance on Information Blocking

by Bass, Berry & Sims PLC on

Centers for Medicare & Medicaid Services (CMS) recently published two important guidance statements on so-called "information blocking," i.e., knowingly and willfully limiting or restricting the compatibility or...more

Proposed Medicare Advantage and Part D Regulations for CY 2019 – CMS Takes Aim at Drug Prices

The rising cost of drugs in the U.S. is frequently in the news. So it is not surprising that in its contract year 2019 Proposed Medicare Advantage and Part D Regulations (Proposed Rule), the Centers for Medicare & Medicaid...more

New OIG Project Expands Telemedicine Audits to State Medicaid Programs

by Foley & Lardner LLP on

Following on the heels of its plans to review Medicare payments for telehealth services, the federal Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just announced a new project to review...more

CMS Releases CY 2019 Proposed Rule for Medicare Advantage and Part D

Last Thursday, November 17, 2017, the Centers for Medicare & Medicaid Services (CMS) released its proposed contract year 2019 Medicare Advantage and Part D regulations. The proposed rule is scheduled to be published in the...more

CMS Seeks Demonstration Proposals from State Medicaid Directors to Address the Opioid Epidemic

by Baker Ober Health Law on

CMS solicited input from State Medicaid Directors earlier this month for new strategies to combat the ongoing opioid epidemic. Authorized demonstration proposals would be eligible for federal financial participation to...more

Hospitals & Physician Organizations Summary Report - November 2017

by Benesch on

Uncertainty and pressures continue to mount for healthcare providers, creating a new operating environment – Uncertainty around Medicaid and other programs, the shift to value-based care, margin pressures, the need to search...more

Proposed Regulations Issued Implementing Massachusetts Employer Medical Assistance Contribution (EMAC) Supplemental Contribution

In an earlier post, we reported on the passage of H. 3822, “An Act Further Regulating Employer Contributions to Health Care,” (the “Act”), the purpose of which is to shore up the finances of the Commonwealth’s Medicaid...more

Medicaid Forecast: Slower Enrollment Growth and Higher Spending Growth for FY 2017 – 2018: Results from a 50-State Medicaid Budget...

by Baker Ober Health Law on

On October 19, Kaiser Family Foundation and Health Management Associates hosted a joint briefing to release their 17th Annual 50-State Medicaid Budget Survey for state fiscal years (FY) 2017 and 2018. The survey highlights...more

New Home Health Rules Effective in January 2018—Some Traps for the Unwary

The Centers for Medicare & Medicaid Services (CMS) have issued new Conditions of Participation (CoP) for home health agencies (HHA) that are effective January 13, 2018. The CoP were originally scheduled to take effect on...more

OIG Turns Its Attention to Telehealth Medicaid Compliance

by Baker Ober Health Law on

Telehealth providers participating in and receiving payment from Medicaid for telehealth services should take heed of the newly initiated items included in the OIG's November 2017 Work Plan update. (Beginning June 2017, the...more

The State AG Report Weekly Update

by Cozen O'Connor on

AG Elections- Democrat Justin Nelson Launches Campaign for Texas Attorney General- Democrat Justin Nelson declared his candidacy for Texas AG seeking to unseat incumbent Republican AG Ken Paxton, who is running for...more

Blog: OIG Releases November Work Plan Items; Focus on Opioid Prescribing and Telemedicine

by Cooley LLP on

As we announced earlier this year, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The November updates include 4 new Work Plan items: - 1....more

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