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Medicaid › Value-Based Payments

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 -
Manatt, Phelps & Phillips, LLP

CMMI's Transforming Maternal Health Model: Considerations for State Medicaid Agencies

Manatt, Phelps & Phillips, LLP on

On December 15, 2023, the CMS Innovation Center (CMMI) announced a new voluntary model for state Medicaid agencies called Transforming Maternal Health (TMaH). TMaH was developed in response to the profound maternal morbidity...more

Proskauer - Health Care Law Brief

Long Awaited Approval of the 1115 Waiver Amendment for NYS Medicaid – Just in Time for the New York State Executive Budget State...

Proskauer - Health Care Law Brief on

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently...more

King & Spalding

CMS Solicits Comments on Improving Medicare Advantage Data Transparency

King & Spalding on

On January 25, 2024, CMS released a Request for Information (RFI) seeking public input on how it can enhance and increase transparency of Medicare Advantage (MA) data. CMS says that the RFI “builds on our existing MA data...more

Manatt, Phelps & Phillips, LLP

Accessing Cell and Gene Therapies: Insights on Coverage, Reimbursement and Emerging Models

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Editor’s Note: In a new white paper, summarized below, Manatt Health discusses emerging reimbursement models for cell and gene therapies. The paper provides an overview of current Medicaid, Medicare and commercial coverage,...more

Harris Beach PLLC

New York Issues Technical Specifications Manual that Addresses Medicaid Payment Reporting

Harris Beach PLLC on

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

Manatt, Phelps & Phillips, LLP

Oregon’s Glide Path to a Basic Health Program Following the End of Medicaid Continuous Coverage

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In December 2022, Oregon became the first state since New York (2015) and Minnesota (2016) to put forth a plan to seek federal approval for implementation of a basic health program (BHP) under Section 1331 of the Affordable...more

Manatt, Phelps & Phillips, LLP

Designing and Launching Hospital-at-Home Models: Strategic Imperatives for Health System Leaders

Manatt, Phelps & Phillips, LLP on

Introduction - Hospital-at-home programs enable patients to receive acute care in their home environment. These programs have proliferated due to the COVID-19 pandemic and subsequent surge in hospitalizations, which has...more

Cozen O'Connor

CMS Releases Final Stark Rules To Promote Value-Based Care

Cozen O'Connor on

On Friday, November 20, 2020, the Centers for Medicare and Medicaid Services (“CMS”) released final regulations to remove certain barriers to the implementation of physician compensation arrangements under value-based payment...more

Manatt, Phelps & Phillips, LLP

Measuring Quality Contraceptive Care in a Value-Based Payment System

Manatt, Phelps & Phillips, LLP on

In 2016, the National Quality Forum (NQF) endorsed three contraceptive care quality measures to assess the degree to which women access effective methods of contraception. This endorsement is an important milestone in quality...more

Obermayer Rebmann Maxwell & Hippel LLP

TRANSPARENCY: Embracing CMS’s Push To Publicize Your Organization’s Performance

Obermayer Rebmann Maxwell & Hippel LLP on

The Centers for Medicare and Medicaid Services (CMS) is launching new value-based programs with great fervor as a central strategy to bend the healthcare cost curve. Value-based reimbursement models linked to achieving the...more

Akerman LLP - Health Law Rx

Possible Changes to Stark Law in 2019

Akerman LLP - Health Law Rx on

Last summer The Centers for Medicare and Medicaid Services (CMS) solicited input on potential amendments to the federal Physician Self-Referral Law (the Stark Law)....more

Bradley Arant Boult Cummings LLP

CMS Continues Shift toward Value-Based Payments with New Home Health Groupings Model in Proposal - Healthcare Alert

Bradley Arant Boult Cummings LLP on

On July 2, 2018, the Centers for Medicare & Medicaid Services (CMS) published its annual proposed rule outlining both payment and policy changes for home health agencies. In a press release announcing the proposed rule, CMS...more

Manatt, Phelps & Phillips, LLP

Manatt on Health: Medicaid Edition - May 2018

Manatt, Phelps & Phillips, LLP on

As healthcare costs continue to rise and stakeholders maintain focus on improving quality of care and outcomes, payors for healthcare services are turning to value-based payment (VBP) as one tool to inject greater value into...more

Epstein Becker & Green

New Audits and Penalties on Medicaid Plans and Providers Related to Encounter Data in Value-Based Payment Models

Epstein Becker & Green on

For value-based payments, encounter data[1] provides valuable information in much the same way that claims data does for fee-for-service arrangements. With the growing prevalence of value-based payments, especially in the...more

Troutman Pepper

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

Troutman Pepper 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

Manatt, Phelps & Phillips, LLP

Medicaid at a Crossroads: What's at Stake?

Manatt, Phelps & Phillips, LLP on

Editor's Note: Since its inception 50 years ago, Medicaid has evolved from a small welfare program into an integral part of the nation's health insurance system, now covering more than one in five low-income children and...more

Burr & Forman

2016 Health Care Year in Review

Burr & Forman on

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

Manatt, Phelps & Phillips, LLP

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

Manatt, Phelps & Phillips, LLP on

The incoming Trump Administration selects HHS and CMS leadership; Alaska moves forward with its proposed 1332 waiver for its ACA reinsurance program; and a new Manatt Health report considers the role of Medicaid supplemental...more

Holland & Knight LLP

CMS Finalizes Sweeping Changes to Medicare Physician Payments

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Oct. 14, 2016, released the highly anticipated Final Rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP...more

Carlton Fields

MACRA: Top 10 FAQs

Carlton Fields on

Significant changes to the Medicare payment system are underway. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is set to take effect January 1, 2017. MACRA represents a deliberate departure by the...more

McDermott Will & Emery

Digital Health: An Improving Environment for Investors

McDermott Will & Emery on

The integration of technology into health care delivery is exploding throughout the health industry landscape. Commentators speculating on the implications of the information revolution’s penetration of the health care...more

Polsinelli

Understanding the Implications of MACRA, MIPS and APMs

Polsinelli on

On May 9, 2016, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking to implement the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Although the...more

Manatt, Phelps & Phillips, LLP

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

Manatt, Phelps & Phillips, LLP on

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

Mintz - Health Care Viewpoints

MA Health Policy Updates – Moves to Strengthen HPC and Expand Telemedicine

Mintz - Health Care Viewpoints on

In a recent Alert, the Mintz Levin Health Law Practice and ML Strategies provided a comprehensive look at recent developments in Massachusetts health policy. In addition to a detailed report on recent Health Policy Commission...more

Mintz - ML Strategies

Recent Developments in Massachusetts Health Policy

Mintz - ML Strategies on

Building on the momentum of early October hearings on the state’s growing health care expenditures, the Health Policy Commission (HPC), the Joint Committee on Health Care Financing, Governor Charlie Baker, and others spent...more

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