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Tag archives: Medicaid

Medicaid update: CMS again approves Kentucky HEALTH Medicaid demonstration

On November 20, 2018, the Centers for Medicare & Medicaid Services (“CMS”) again approved the Kentucky HEALTH 1115 demonstration.  Kentucky HEALTH  was the first Section 1115 demonstration that CMS approved with a work and community engagement requirement as a condition of eligibility for coverage under Medicaid.  The demonstration requires certain Medicaid beneficiaries to engage in … Continue reading

CMS proposes to expand payment for telehealth services

On July 12, 2018, CMS included three proposed changes to telehealth reimbursements within the CY 2019 Physician Fee Schedule (the “Proposed Rule”). Currently, subject to certain exceptions, Medicare reimbursements for certain telehealth services are statutorily limited by the type of health care professional providing the service, and the geographic location of the patient (namely, the … Continue reading

CMS further crystalizes Stark liberalizations

On July 12, 2018, CMS included within the CY 2019 Physician Fee Schedule (the “Proposed Rule”) two revisions to Stark Law regulations aimed at further clarifying any actual or perceived differences between current regulations and the recently enacted Bipartisan Budget Act of 2018 (“2018 BBA”). As we previously reported, Section 50404 of the 2018 BBA … Continue reading

CMS issues Pathway to Success ACO proposed rule

On August 9, 2018, CMS published the long-awaited Pathways to Success proposed rule.  CMS Administrator Seema Verma published a related  article on the Health Affairs Blog.  The proposed rule would usher in significant changes for Accountable Care Organizations (ACOs).  Groups of providers, such as doctors and hospitals, can join together to form an ACO and … Continue reading

GAO releases report on the differences between 340B and non-340B hospitals

On June 18, the United States Government Accountability Office (GAO) released a report on the 340B program, entitled “Drug Discount Program: Characteristics of Hospitals Participating and Not Participating in the 340B Program.” The 340B Drug Discount Program requires drug manufacturers to provide discounts on outpatient drugs to certain categories of eligible hospitals. Hospitals that serve … Continue reading

CMS opens new comment period for Kentucky HEALTH

“In light of the district court’s decision in Stewart v. Azar,” CMS has opened a new 30-day comment period for the Kentucky HEALTH demonstration project that would implement work or community engagement requirements as a condition of eligibility.  On June 29, 2018, Judge James E. Boasberg of the U.S. Federal District Court for the District … Continue reading

Status of Medicaid reform in Kentucky, Mississippi and Maine

On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) sent a letter to State Medicaid Directors that signaled their support of section 1115 demonstration projects that include work or community engagement requirements, as previously summarized in the Health Law Pulse. CMS prompted State Medicaid Directors to respond to this letter with proposals … Continue reading

US DOJ charges 601 individuals in nation’s largest healthcare fraud takedown

Last week, the U.S. Department of Justice announced charges against 601 individuals for their alleged participation in healthcare fraud schemes. According to the announcement, the alleged fraud is estimated to have resulted in more than $2 billion in losses to federal healthcare programs. This national healthcare fraud takedown is the largest in U.S. history, surpassing … Continue reading

Virginia to expand Medicaid in January 2019; Utah will vote on Medicaid expansion this November

Virginia is expected to become the 33rd state (plus the District of Columbia) to expand Medicaid under the Affordable Care Act (ACA) following the passage of a budget by the Virginia legislature.  The expansion will take effect on January 1, 2019 and it is expected to provide coverage to close to 400,000 individuals.  Prior attempts … Continue reading

Maine court hears argument on Medicaid expansion

Maine Superior Court Justice Michaela Murphy heard arguments on May 24, 2018 about whether Governor Paul LePage must take steps to expand Medicaid in Maine.  In April, a group of residents and advocacy organizations filed a lawsuit against Maine’s Department of Health and Human Services (DHHS) for failing to expand Medicaid following the November 2017 … Continue reading

Recent effort to regulate pharmaceutical pricing deemed unconstitutional by Fourth Circuit

In the absence of federal action, states have attempted to rein in high pharmaceutical pricing by enacting laws aimed at regulating drug pricing. Following what now has become a trend, on March 13, 2018, Oregon became the newest state to enact such legislation, The Prescription Drug Price Transparency Act, H.B. 4005. But many of these … Continue reading

Congressional hearings held on the Trump administration’s FY 2019 budget request and health care industry consolidation

On February 14, 2018, the Centers for Medicare & Medicaid Services (CMS) announced projections that national health care spending is expected to increase an average of 5.5% a year between 2017 – 2026 and will account for almost 20% of Gross Domestic Product by 2026.  This announcement provides context for the continued focus on controlling … Continue reading

Centers for Medicare & Medicaid Services commits to supporting Medicaid work and community engagement requirements

On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) released a letter to State Medicaid Directors announcing a commitment to support section 1115 demonstration projects that include work or community engagement requirements.  This will be the first time in the fifty year history of the Medicaid program that work requirements will be … Continue reading

CHIP Program funding remains in limbo; Senators advocate reversal of 340B Drug Discount Program cuts; CMS reports on 2016 U.S. health expenditures

Payments under the Children’s Health Insurance Program (CHIP) remain uncertain in many states without an extension of federal funding to the program. CHIP provides insurance coverage for children whose parents earn too much for Medicaid but cannot afford other health insurance coverage. While the short-term spending bill signed into law on December 8 allows for … Continue reading

Senate tax bill would effectively repeal ACA individual mandate; House legislation to reverse 340B Drug Discount Program cuts; CMS addresses prescription drug costs and the opioid crisis

On November 14, Senate Finance Committee Chairman Orrin Hatch (R-UT) released the Chairman’s Mark to the Senate version of the Tax Cuts and Jobs Act. Hatch’s version of the tax plan effectively repeals the Affordable Care Act (ACA) individual mandate by reducing the associated penalty to $0. The ACA individual mandate requires individuals to buy … Continue reading

U.S. Senate Republican leadership decides against full Senate vote on Graham-Cassidy ACA repeal and replace legislation; HHS Secretary Tom Price resigns under pressure from the White House

On Tuesday, September 26, Senate Republican leadership decided not to hold a full Senate vote on the Graham-Cassidy Affordable Care Act (ACA) repeal and replace legislation. The previous day, Monday, September 25, the Senate Finance Committee held a hearing on the Graham-Cassidy bill. Following the hearing, Senator Susan Collins (R-ME) announced her opposition to the … Continue reading

US Senators Graham and Cassidy revise Affordable Care Act repeal legislation prior to Finance Committee hearing; AHA requests CMS guidance on hospital co-location and shared space arrangements

On Sunday evening, September 24, U.S. Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana) released a revised version of their Affordable Care Act (ACA) repeal legislation in advance of the Senate Finance Committee hearing scheduled for Monday, September 25, at 2 PM EST. The amended bill is similar to the legislation previously released in … Continue reading

CMS clarifies when hospitals are primarily engaged in inpatient care; U.S. Republican Senators introduce ACA repeal legislation while Democrats promote Medicare for all

The Centers for Medicare and Medicaid Services (CMS) recently issued Survey and Certification Letter 17-44, clarifying what it means for a facility to be “primarily engaged” in inpatient care for purposes of meeting the definition of a hospital and qualifying for reimbursement as a hospital under Medicare and Medicaid. A facility is primarily engaged in … Continue reading

U.S. Senators continue ACA stabilization and repeal efforts

The Senate Health, Education, Labor and Pensions (HELP) Committee has held three hearings in the past few days attempting to reach a bipartisan agreement on stabilizing the Affordable Care Act (ACA) insurance markets and will hold a fourth hearing later this week.  HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Minority Member Patty Murry (D-WA) … Continue reading

CMS extends deadline for health insurers to file 2018 rate requests; bipartisan group of experts advocates certain health reform initiatives

On August 11, the Centers for Medicare & Medicaid Services sent a memorandum to insurers announcing an extension of the deadline by almost three weeks until September 5 for insurers to file their 2018 rate requests.  Insurers are wrestling with whether to participate in the Affordable Care Act exchanges/marketplaces in 2018, and if so, the … Continue reading

Health care reform discussions continue in U.S. Senate; CMS issues multiple rules relevant to payments to and policies for hospitals, hospices, and skilled nursing facilities

On August 1, Chairman Lamar Alexander (R-Tenn.) and Ranking Minority Member Patty Murray (D-Wash.) of the U.S. Senate Committee on Health, Education, Labor and Pensions announced that the committee will hold hearings the week of September 4th on actions that Congress could take in an attempt to stabilize and strengthen the individual insurance markets in … Continue reading

U.S. Senate rejects health care reform legislation; CMS releases home health proposed rule for CY 2018

Last week the U.S. Senate rejected three health care reform proposals intended to repeal all or parts of the Affordable Care Act (ACA).  On Tuesday, Vice President Mike Pence cast the deciding vote 51-50 for the Senate to begin debate on legislation to repeal significant parts of the ACA.  Later Tuesday evening, however, the Senate … Continue reading

Senate Republican leadership plans vote to begin debate on health care reform legislation; House Budget Committee approves budget resolution; 340B program hearing held

Without enough votes to begin debate on the July 13th version of the “Better Care Reconciliation Act of 2017” on Monday, July 17, Republican leaders in the Senate called for the repeal of the Affordable Care Act (ACA) without an immediate plan to replace the ACA. According to a report issued by the Congressional Budget … Continue reading
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