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Medicaid › Quality of Care Standards

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 -
Stark & Stark

New Jersey’s Nursing Homes: A Closer Look at CMS’s Special Focus Facilities

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In April of 2024, Centers for Medicare & Medicaid Services (CMS) updated their list of Special Focus Facilities. Special Focus Facilities (SFFs) are “nursing homes that have a history of serious quality issues and are...more

McDermott+

Policy Update - CMS Releases Final Rule: Medicaid Program; Ensuring Access to Medicaid Services

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On April 22, 2024 the Centers for Medicare & Medicaid Services (CMS) published the Medicaid Program; Ensuring Access to Medicaid Services final rule. The rule has a particular focus on home- and community-based services...more

Manatt, Phelps & Phillips, LLP

[Webinar] Final Medicaid Rules, Part Three: Home and Community Based Services - June 4th, 10:00 am - 11:00 am PT

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This program is part three of Manatt’s New Federal Rules on Medicaid Access and Managed Care webinar series. After releasing sweeping proposed rules on Medicaid access and managed care in spring 2023, the Centers for...more

WilmerHale

OIG Issues New Advisory Opinion on Federal Anti-Kickback Statute

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The Department of Health and Human Services Office of Inspector General (OIG) recently issued an advisory opinion that explored the limits of a relatively new safe harbor to the federal Anti-Kickback Statute (AKS) that aims...more

Manatt, Phelps & Phillips, LLP

[Webinar] Proposed Rules on Medicaid Payments, Access and Quality: Implications for Health Care Stakeholders - June 20th, 1:00 pm...

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On Thursday, April 27, the Centers for Medicare & Medicaid Services (CMS) released two highly anticipated proposed rules... Together, these would reshape the federal regulatory landscape for Medicaid and the Children’s Health...more

Manatt, Phelps & Phillips, LLP

[Webinar] Proposed Rules to Enhance Access and Quality for Medicaid HCBS and Strengthen the HCBS Workforce - June 1st, 1:00 pm -...

Manatt, Phelps & Phillips, LLP on

On April 27, 2023, the Centers for Medicare & Medicaid Services (CMS) released proposed rules that, if finalized, would reshape Medicaid’s federal regulatory landscape in several ways, including with respect to home and...more

Weintraub Tobin

Proposed Medicare and Medicaid Enrollment Rule for Skilled Nursing Facilities Implements Law Expanding Regulation of Private...

Weintraub Tobin on

On February 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) proposed a long-delayed regulation that would implement a provider enrollment provision of the Affordable Care Act that expands the information...more

ArentFox Schiff

Increased Federal Attention to Skilled Nursing Facility Compliance and Quality Improvement Results in Modified Program...

ArentFox Schiff on

The Biden Administration has embraced an aggressive and multi-part agenda designed to improve the safety and quality of care nationally in skilled nursing facilities (SNFs). The Biden Administration’s nursing home agenda...more

ArentFox Schiff

OIG Declines To Challenge Debt Cancellation and Restructured Financial Arrangements Between Health System and FQHC “Look-Alike”...

ArentFox Schiff on

In Advisory Opinion 22-17, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) concluded that a proposed restructuring of a loan and other contractual relationships between a health system...more

Holland & Knight LLP

CMS Releases FY 2022 IPPS and LTCH Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) on April 27, 2021, released the Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Prospective Payment...more

Bricker Graydon LLP

Ohio nursing home quality of care addressed in draft executive budget

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A draft of Ohio Governor DeWine’s State Fiscal Year 2022-2023 Executive Budget Proposal includes provisions to address quality of care in the state’s nursing homes....more

Bass, Berry & Sims PLC

Tennessee Nursing Home Chain Reaches “Largest Worthless Services Resolution in Tennessee’s History”

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Government Settles with Several Entities, Individuals - Last week, Vanguard Healthcare and related entities reached a settlement with the Department of Justice (DOJ) for the stated amount of more than $18 million to settle...more

Sheppard Mullin Richter & Hampton LLP

Blog Series Part 4: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug...

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Quality Improvement Programs - The proposed rule issued November 1, 2018 (the “Proposed Rule”) by the Centers for Medicare and Medicaid Services (“CMS”) includes two technical changes to 42 C.F.R. Part 422. The first change...more

Pullman & Comley - Connecticut Health Law

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

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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

Pullman & Comley, LLC

ALERT: HHA's Should Make Use of Delay in New Medicare Rules

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Now that the Centers for Medicare & Medicaid Services (CMS) have published a Final Rule delaying the effective date of the revised Medicare Conditions of Participation (CoP) for home health agencies (HHAs) until January 13,...more

Mintz - Health Care Viewpoints

OIG Publishes Semiannual Report to Congress

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Earlier this month, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) published its Semiannual Report to Congress covering the period from October 1, 2016 to March 31, 2017. The...more

Stinson LLP

CMS Proposes Six-Month Delay for New Medicare and Medicaid Conditions of Participation for Home Health Agencies

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The Centers for Medicare & Medicaid Services (CMS) recently proposed a six-month delay for home health agencies (HHAs) to implement the revised conditions of participation (CoPs) that HHAs must satisfy to participate in the...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: Monthly Expansion Recap - March 2017

Manatt, Phelps & Phillips, LLP on

Arizona - Appeals Court Hears Arguments in Medicaid Expansion Lawsuit - A three-judge State Appeals Court panel heard an appeal of the Maricopa County Superior Court's decision that Arizona's Medicaid expansion plan...more

Stinson LLP

CMS Issues Final Rule on New Medicare and Medicaid Conditions of Participation for Home Health Agencies

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The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule, 42 C.F.R. pt. 484, implementing significant changes to the conditions of participation (CoPs) that home health agencies (HHAs) must satisfy to...more

Ruder Ware

CMS Releases the First Comprehensive Overhaul of Nursing Home Conditions of Participation in Over 25 Years

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On October 4, 2016, the Center for Medicare and Medicaid Services (CMS) published a final rule to revise the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. CMS...more

Foley & Lardner LLP

CMS Update to Medicaid Managed Care Regulations Should Prompt Significant Change

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The Centers for Medicare & Medicaid Services (“CMS”) has released the final version of its much anticipated revisions to the regulations governing Medicaid managed care (the “Final Rule”). First proposed in May 2015, the...more

Mintz - Health Care Viewpoints

Groundbreaking Multi-Payer Alignment on Core Measures for Quality-Based Payments

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For too long, health industry stakeholders have bandied about massive amounts of information that could not be used in a comparative sense. Both public and private payers had their own proprietary reporting metrics,...more

King & Spalding

CMS Proposes to Revise Payment System for Joint Replacements

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On July 9, 2015, CMS released a proposed rule to revise how it pays for joint replacement procedures like hip and knee replacements, also known as lower extremity joint replacements (LEJR). This payment structure, called the...more

Foley & Lardner LLP

Recent OIG Audits of Home Health and Hospice Surveys May Signal Increased Scrutiny on Worker Qualifications

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Recent audits by the Department of Health and Human Services Office of Inspector General (“OIG”) conclude that state survey agencies in a number of states and a leading national accrediting agency serving the home health and...more

Manatt, Phelps & Phillips, LLP

CMS Proposes Overhaul of Medicaid and CHIP Managed Care Rules

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On May 26, 2015, the Centers for Medicare and Medicaid Services (CMS) released a notice of proposed rulemaking (NPRM) to overhaul the regulations governing Medicaid managed care and make conforming changes to the rules that...more

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