Tag archives: Medicaid

CMS Issues Second Round of Regulatory Waivers and Rule Changes

Today, the Centers for Medicare & Medicaid Services (CMS) released an additional round of regulatory waivers and rule changes to support the healthcare system during the COVID-19 pandemic.  The changes include new rules to expand COVID-19 diagnostic testing, increase care capacity and the healthcare workforce, and further promote telehealth services. Medicare no longer requires an … Continue reading

COVID-19 Update: CMS releases additional guidance to states on how the FFCRA and CARES Act provisions apply to Medicaid and CHIP

On Monday, April 13, 2020, CMS released an updated FAQ on the enhanced Federal Medical Assistance Program (FMAP) and the Families First Coronavirus Response Act (FFCRA) implementation, as well as new guidance on CMS’ Coronavirus Aid, Relief, and Economic Security (CARES) Act implementation. In these new resources, CMS explains the following changes, among others, to … Continue reading

Update to Prior CMS Action: CMS Approves 11 New Medicaid Section 1135 Waivers; 13 States Total

On March 13, 2020, following President Trump’s declaration of a national emergency in response to the COVID-19 pandemic, CMS announced its approval of the first Section 1135 Waiver aimed at addressing the spread of COVID-19 (Coronavirus) in Florida. On March 19, CMS granted a Section 1135 Waiver to deal with the COVID-19 outbreak in Washington … Continue reading

COVID-19 Update: Trump administration expands access to telehealth services for Medicare beneficiaries to combat COVID-19

On Tuesday, March 17, 2020, the Trump administration announced that it will immediately expand access to telehealth services for all Medicare beneficiaries during the COVID-19 outbreak. In coordination with this announcement, the Office for Civil Rights at the Department of Health & Human Services (HHS) released a notification stating that HHS has temporarily suspended certain … Continue reading

CMS Proposes Major Changes in Medicaid Fiscal Accountability Rule

On November 12, 2019, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule for public inspection entitled Medicaid Fiscal Accountability Regulation. CMS states that the intent of the proposed rule is to ensure that state supplemental payments and financing arrangements under the Medicaid program are consistent with federal statutory requirements. In a … Continue reading

Medicaid Update: D.C. Circuit Court of Appeals Reviews CMS Approval of Medicaid Work and Community Engagement Eligibility Requirements

Today, October 11, 2019, the United States Court of Appeals for the D.C. Circuit is hearing oral arguments in Stewart v. Azar (Case No. 19-5095), an appeal from the federal district court’s rulings invalidating three prior approvals of Section 1115 Waivers in Kentucky and Arkansas that would have implemented work and community engagement requirements as … Continue reading

MEDICAID ALERT: Work and community engagement requirements blocked by federal court

“As Opening Day arrives, the Court finds its guiding principle in Yogi Berra’s aphorism, “It’s déjà vu all over again.”” – Judge James Boasberg, Gresham v. Azar. On March 27, United States District Court for the District of Columbia Judge James Boasberg ruled that Department of Health & Human Services Secretary Azar’s approval of work … Continue reading

OIG publishes Medicaid Fraud Control Units Fiscal Year 2018 Annual Report

On March 25, 2019, the Office of Inspector General (OIG) published its Medicaid Fraud Control Units Fiscal Year 2018 Annual Report. Forty-nine states and the District of Columbia have a Medicaid Fraud Control Unit (MFCU) which is responsible for investigating and prosecuting Medicaid provider fraud and patient neglect and abuse. The report notes that it … Continue reading

Centers for Medicare and Medicaid Innovation announces emergency transportation model

On February 14, 2019, the Center for Medicare and Medicaid Innovation (CMMI) announced the Emergency Triage, Treat, and Transport (ET3) Model that aims to transform the ambulance system.  Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers will participate in the model.   CMMI believes this model will improve quality and lower costs by reducing hospitalizations and … Continue reading

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
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