News & Analysis as of

Social Security Act

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

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

CMS Announces Revisions to State Operations Manual for Hospitals “Primarily Engaged” in Providing Care to Inpatients

by King & Spalding on

On September 6, 2017, CMS’s Center for Clinical Standards and Quality/Survey & Certification Group announced revisions to Appendix A of the State Operations Manual (SOM), which governs hospital surveys. The revisions are...more

What Hospitals Need to Know About the Natural Disaster Exception to Stark Law

by Baker Ober Health Law on

Hospitals operating in regions affected by the recent hurricanes and other natural disasters may be able to obtain temporary regulatory relief. During times of disasters and emergencies, CMS can provide some flexibility...more

Disputing Inaccurate Reports Under the Physician Payment Sunshine Act

by Ruder Ware on

The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical...more

OIG Exclusion Regulations Go Into Effect This Month

by King & Spalding on

On January 20, 2017, Assistant to President Trump and Chief of Staff Reince Priebus directed Federal agencies to temporarily postpone the effective date of such regulations for sixty days (March 21, 2017) unless such action...more

New OIG Exclusion Regulations About to Go into Effect

by McDermott Will & Emery on

The Office of Inspector General (OIG) recently published a final rule regarding its exclusion authorities. The final rule goes into effect March 21, 2017, and expands OIG’s authority to exclude certain individuals and...more

What’s Next Under the Congressional Review Act?

As we reported, the House and Senate have passed a joint resolution under the Congressional Review Act disapproving the SEC Resource Extraction Rule and that President Trump was expected to sign the legislation that...more

HHS Issues Rules Expanding OIG’s Exclusion Authorities

by Tucker Arensberg, P.C. on

On January 12, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) issued final rules implementing permissive exclusion authorities authorized by the Affordable Care Act expanding...more

HHS OIG Finalizes New Exclusion Rules as Administration Exits

by Hogan Lovells on

With just a week left before a new administration takes office, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) finalized changes to the regulations authorizing OIG to exclude...more

OIG Raises ‘Nominal Value’ for Gifts to Medicare and Medicaid Beneficiaries

by McGuireWoods LLP on

On Dec. 7, 2016, just in time for the holiday season, the Office of Inspector General (OIG) released a policy statement regarding the nominal value of gifts that healthcare providers may give to Medicare and Medicaid...more

Special Needs Fairness Act

by Tucker Arensberg, P.C. on

On December 14, 2016, President Obama signed the Special Needs Trust Fairness Act into law amended federal law to enable disabled individuals to establish their own first-party payback Special Needs Trusts under 42 U.S.C. §...more

Commercial Insurers Urge Congressional Budget Office to Consider their Telemedicine Data

by McDermott Will & Emery on

In hopes of expanding reimbursement opportunities for telemedicine services in the Medicare program, representatives of eleven payers, including Aetna, Anthem, Blue Cross Blue Shield of Tennessee, Cambia Health Solutions and...more

Ten Things to Know About the CMS Long-Term Care Requirements Final Rule

by Holland & Knight LLP on

Deadlines are looming to come into compliance with sweeping changes to the Centers for Medicare & Medicaid Services (CMS) requirements for long-term care facilities (LTC) participating in Medicare and Medicaid. The CMS final...more

Senate Bill Targets Part D DIR Fees

Just last month the “Improving Transparency and Accuracy in Medicare Part D Spending Act” was introduced in the Senate to amend the Social Security Act. The bill seeks to prohibit Part D plans (and their contracted pharmacy...more

Oregon Requests $1.25 Billion from CMS to Expand Medicaid Coordinated Care Model Demonstration Waiver

by King & Spalding on

Oregon has requested $1.25 billion in federal funding to expand the Oregon Health Plan (OHP), a coordinated care model implemented under Section 1115(a) of the Social Security Act. The current OHP Section 1115 demonstration...more

Medicaid Managed Care Transitions’ Impact On Brain Injury Waiver Populations

As of June 2015, 24 states utilize a traumatic or acquired brain injury waiver,1 as provided under section 1915(c) of the Social Security Act, which are designed to help individuals with traumatic brain injury (TBI) live in...more

GAO Calls For Mandatory Medicare Drug ASP Reporting, CMS Verification of Drug Pricing

by Reed Smith on

A recent Government Accountability Office (GAO) report, “Medicare Part B: CMS Should Take Additional Steps to Verify Accuracy of Data Used to Set Payment Rates for Drugs,” questions the reliability of pricing for Medicare...more

Bankruptcy Courts Lack Subject Matter Jurisdiction Over Medicare Issues, Eleventh Circuit Rules

by Baker Ober Health Law on

In a detailed opinion that likely constitutes the last word on the matter, the Eleventh Circuit recently held in Fla. Agency for Health Care Administration v. Bayou Shores SNF, LLC that bankruptcy courts lack jurisdiction...more

New Exclusion Guidance Includes Presumption of Compliance Plan

Section 1128 of the Social Security Act (42 U.S.C. 1320a–7) (available here) established mandatory and permissive authority for exclusion of health care providers from Federal health care programs based on provider conduct. ...more

U.S. Department of Health and Human Services Updates Criteria for Permissive Exclusion Under Section 1128(b)(7) of the Social...

The HHS-OIG issued new guidelines on April 18, 2016 regarding the Secretary's exercise of the Department's permissive exclusion authority pursuant to Section 1128(b)(7) of the Social Security Act. The HHS-OIG's new guidance...more

Blog: OIG Releases Criteria For Implementing Exclusion Authority

by Cooley LLP on

On April 18, 2016, the Health and Human Services Office of Inspector General (OIG) released updated guidance related to the criteria it may use for evaluating its permissive exclusion authority under Section 1128(b)(7) of the...more

OIG Issues New Guidance on Its Evaluation Process and Non-Binding Criteria for Section 1128(b)(7) Exclusions

by Epstein Becker & Green on

On April 18, 2016, the Office of Inspector General (“OIG”) of the Department of Health and Human Services issued a revised policy statement applicable to exclusions imposed under Section 1128(b)(7) of the Social Security Act...more

Manatt on Medicaid: CMS Approves Alabama's Delivery System Reform Waiver

On February 9, 2016, the Centers for Medicare and Medicaid Services (CMS) approved Alabama's request for a waiver under Section 1115 of the Social Security Act. The waiver enables the transition of the State's Medicaid...more

4 Key Things to Watch on Recent Finding Related to Medicare Appeals Backlog

by Polsinelli on

On Feb. 9, 2016, the D.C. Circuit found that the lower court has the authority to order the Department of Health & Human Services (HHS) to resolve the massive backlog of Medicare appeals tied up in the administrative law...more

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