C&M Health Law

C&M Health Law

Analysis, commentary, and the latest developments in health care law and policy

Category Archives: Medicaid

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Upcoming Webinar: Looking Back & Looking Beyond – The First 100 Days in Health Care Policy

Posted in Events, Exchanges, Fraud, Waste & Abuse, Health Care Reform & ACA, Medicaid, Medicare
On Tuesday, April 18, 2017, our Health Care Group will hold a webinar on the health care policy and transition challenges still at play as the Trump Administration nears the end of its 100 days in power.  During the webinar, participants will hear important insights and predictions on what a Trump-led Executive Branch will mean… Continue Reading

ACA Repeal and Replace Update: President Trump’s Executive Order Directs Executive Branch to Minimize the Economic Burden of the ACA

Posted in Exchanges, Health Care Reform & ACA, Medicaid, Tax
On January 20, 2017, hours after being sworn in as the 45th president of the United States, President Donald Trump issued Executive Order 13765 that aims to “minimize the unwarranted economic and regulatory burdens” of the Affordable Care Act (ACA) while its repeal is “pending.”  The one-page Executive Order declares that it is the policy… Continue Reading

CMS Publishes Interim Final Rule to Address Third-Party Payment of Insurance Premiums by Medicare-certified Dialysis Providers

Posted in Exchanges, Fraud, Waste & Abuse, Health Care Reform & ACA, Medicaid, Medicare
On December 14, 2016, CMS issued an interim final rule with comment period to amend Medicare’s dialysis facility conditions for coverage to require certain disclosures to patients and health insurance issuers to address widespread concerns over inappropriate steerage of dialysis patients to individual market plans. After issuing an RFI about “inappropriate steering of people eligible… Continue Reading

CMS Renews Focus on Third-Party Payment of Insurance Premiums Steering Medicaid & Medicare Eligibles into Marketplace Plans

Posted in Exchanges, Fraud, Waste & Abuse, Health Care Reform & ACA, Medicaid, Medicare
On August 18, 2016, CMS issued a request for information on “inappropriate steering of people eligible for Medicare or Medicaid into Marketplace plans” by third parties. CMS voiced concern over “anecdotal reports” that Medicaid or Medicare eligibles received premium and cost-sharing assistance from third parties so they could enroll in Marketplace plans, enabling providers to… Continue Reading

Medicaid Managed Care Final Rule: Prevention of Fraud, Waste, and Abuse

Posted in Fraud, Waste & Abuse, Medicaid
The Medicaid Managed Care Final Rule aims to align Medicaid regulations with those of other health coverage programs, modernizing the post-Affordable Care Act healthcare landscape. Among other goals, the Final Rule seeks to bolster the transparency, accountability, and integrity of Medicaid managed care by imposing and clarifying requirements meant to reduce fraud, waste, and abuse.… Continue Reading

Senate Finance Committee Members Hear from Partner Troy Barsky and Hospital System Executives on Necessary Stark Law Reforms

Posted in Fraud, Waste & Abuse, Health Care Reform & ACA, Medicaid, Medicare
Yesterday, our colleague Troy A. Barsky testified before the U.S. Senate Finance Committee led by Chairman Orrin Hatch (R-Utah) and provided recommendations for modernizing the Stark Law to regulate self-referrals without impeding the care coordination and value-based payment models promoted by health care reform legislation. Other witnesses before the Committee included Dr. Ronald A. Paulus,… Continue Reading

In Advance of Senate Finance Committee Hearing on Stark Law Next Week, the Committee Releases Stark Law White Paper

Posted in Events, Fraud, Waste & Abuse, Medicaid, Medicare
On Tuesday July 12, 2016, the Senate Finance Committee (“Committee”) will hold a hearing on “Examining the Stark Law: Current Issues and Opportunities.” Crowell & Moring Partner Troy Barsky will be testifying before the Committee as a Stark Law subject matter authority. In advance of this hearing, the Committee released last week the white paper… Continue Reading

Network Adequacy for Medicaid Managed Care: New Standards under the Final Rule

Posted in Medicaid
The Medicaid Managed Care Final Rule addresses managed care plan network issues while preserving significant flexibility for the states in designing the standards.  The Rule adds a new regulation (42 C.F.R. § 438.68) on network adequacy standards for medical care and Long-Term Services and Supports (LTSS) as well as one related to availability of services… Continue Reading

Medicaid Managed Care Final Rule: Regulatory Convergence in a Post-ACA World, Novelty, and Modernizing Medicaid Managed Care

Posted in Fraud, Waste & Abuse, Medicaid, Medical Loss Ratios
On May 6, 2016, CMS published the Medicaid managed care final rule in the Federal Register. The Final Rule overhauls Medicaid managed care for the first time in 14 years and tracks many of the industry-wide developments that followed enactment of the ACA. Given the breadth of the rule, Crowell & Moring is covering it… Continue Reading

Medicaid Matching Funds Available to Connect Providers Eligible for Meaningful Use with other Providers

Posted in Health IT, Medicaid
There is a very significant funding opportunity for State Medicaid Programs, which can support use of health information technology by health care providers that provide care to Medicaid recipients and those who may exchange information with Medicaid providers eligible for Meaningful Use incentives. It may also benefit technology developers that are engaged in health information… Continue Reading

Medicaid Rules for Covered Outpatient Drugs Finalized by CMS; SIPs Required To Be Modified By April 1, 2017

Posted in Health Care Reform & ACA, Medicaid
Almost four years after publishing its proposed rule, the Centers for Medicare & Medicaid Services (CMS) released its final rule on February 1, 2016, pertaining to Medicaid reimbursement for covered outpatient drugs.  The finalized regulations implement provisions of the Affordable Care Act, and revise several key aspects of Medicaid program on drug rebates, and coverage… Continue Reading

Congress Introduces Bipartisan Bill to Expand Telehealth, Remote Patient Monitoring

Posted in Fraud, Waste & Abuse, Health IT, Medicaid, Medicare
Last week, Democrats and Republicans from both chambers introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (S. 2484, H.R. 4442), which would improve health care quality and realize cost savings by eliminating current restrictions on telehealth and remote patient monitoring. Click here to read our detailed analysis of… Continue Reading

Crowell & Moring’s 2016 Litigation & Regulatory Forecasts: What Corporate Counsel Need to Know for the Coming Year

Posted in Administrative Law, Antitrust, EHR, Health Care Reform & ACA, Health IT, Litigation, Medicaid, Medicare, Tax
Featured Industry: Health Care Spotlight on Best Practices, Litigation, Antitrust, and Tax for Health Care Companies Crowell & Moring LLP is pleased to release its “2016 Litigation & Regulatory Forecasts: What Corporate Counsel Need to Know for the Coming Year.” The reports examine the trends and developments that will impact health care companies and other… Continue Reading

2016 Appropriations Act Stalls ACA Taxes, Impacts Risk Corridors, and Tweaks Medicare & Medicaid Payments

Posted in Health Care Reform & ACA, Medicaid, Medicare
The recent appropriations law, which will fund the federal government through 2016, suspends three health care taxes enacted under the Affordable Care Act, continues to limit how the Centers for Medicare & Medicaid Services can fund the temporary risk corridors program for the exchanges, and refines Medicare and Medicaid payments and funding. Click here for… Continue Reading

Crowell’s Long-Term Care Policy Update—Recapping the Discussions and Debates

Posted in Health Care Reform & ACA, Medicaid, Medicare
On April 17th, Crowell & Moring’s Government Affairs and Health Care Groups hosted speakers from Capitol Hill, federal agencies, and national trade groups during a thought-provoking half-day Long Term Care Policy Update forum (“LTC Forum”).  The LTC Forum was spearheaded by James Flood and Scott Douglas, who recently joined the firm from the Government Affairs… Continue Reading

CMS Proposed Rule Implements Mental-Health Parity Requirements for Medicaid Managed Care and CHIP Plans

Posted in Medicaid, Mental Health Parity
On April 6, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule to implement the 2008 Mental Health Parity and Addiction Equity Act (“MHPAEA”) for coverage offered by Medicaid Managed Care Organizations (“MCOs”), Medicaid Alternative Benefit Plans (“ABPs”) and the Children’s Health Insurance Program (“CHIP”).  MHPAEA requires group health plans and health… Continue Reading

What Corporate Counsel Need to Know in 2015 – Litigation and Regulatory Forecasts from Crowell & Moring

Posted in ERISA, Health Care Reform & ACA, HIPAA & Privacy, Litigation, Medicaid, Medical Loss Ratios, Medicare
Crowell & Moring’s 2015 Litigation and Regulatory Forecasts provide an in-depth look at the trends in the courts and in the regulatory agencies, both inside the Beltway and beyond, that will impact business in the coming year. The Litigation Forecast examines the latest litigation developments facing companies in areas ranging from health care and antitrust… Continue Reading

FY 2016 Proposed Federal Budget’s Potential Impact on Healthcare Industry

Posted in Health Care Reform & ACA, Medicaid, Medicare
The President’s proposed budget, released February 2, includes a number of provisions that will impact the health care industry. Most prominently, the budget would seek savings through modifications to Medicare prescription drug coverage, extend the Children’s Health Insurance Program (CHIP), and continue to push Medicare delivery system reforms.… Continue Reading

Proposed Rule Would Broaden Rights for Same-Sex Couples at U.S. Hospitals

Posted in Medicaid, Medicare
On December 12, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that would broaden rights for same-sex spouses at US hospitals. The proposed rule is aimed at “ensur[ing] that same-sex spouses in legally-valid marriages are recognized and afforded equal rights in Medicare and Medicaid participating facilities.” In its 2013 decision… Continue Reading

CMS Confirms 2015 Deadline for ICD-10 Implementation

Posted in Medicaid, Medicare
On July 31, the Centers for Medicare & Medicaid Services (CMS) issued a final rule establishing October 1, 2015 as the official deadline for the implementation of the International Classification of Diseases, 10th Edition diagnosis and procedures codes (ICD-10). ICD-10 codes are used to classify diagnoses and procedures on claims submitted to Medicare and private… Continue Reading

IRS Promulgates Clarifying Regulations Regarding Abstainer Penalties Under the ACA

Posted in Exchanges, Health Care Reform & ACA, Medicaid, Tax
On January 27, 2014, the Internal Revenue Service (IRS) issued proposed regulations (“Proposed Regulations”, available here) clarifying the penalties imposed on nonexempt persons who fail to maintain minimum essential coverage as required by Internal Revenue Code (Code) Section 5000A. Very generally, Code Section 5000A requires nonexempt persons to either (1) maintain minimum essential coverage, or (2)… Continue Reading

CMS Issues Guidance on Internal Revenue Ruling 2013-17 re Same-Sex Marriage

Posted in Exchanges, Health Care Reform & ACA, Litigation, Medicaid
In the wake of United States v. Windsor, the case in which the Supreme Court held the Defense of Marriage’s (DOMA) prohibition on federal recognition of same-sex marriages unconstitutional, the Internal Revenue Service issued Internal Revenue Ruling 2013-17. The Ruling held that same-sex individuals who were married under state law would be considered married for… Continue Reading

CMS Publishes Proposed Rule on Basic Health Program

Posted in Exchanges, Health Care Reform & ACA, Medicaid
On September 25, 2013, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule to establish the Basic Health Program pursuant to Section 1331 of the Affordable Care Act (ACA). The Basic Health Program aims at assisting individuals whose incomes exceed the threshold for Medicaid and similar programs, but who cannot afford to purchase… Continue Reading

CMS Issues Final Rule Amending Regulations in the Small Business Health Options Program

Posted in Exchanges, Health Care Reform & ACA, Medicaid
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on May 31, 2013, effective July 31, 2013, regarding the Small Business Health Options Program (SHOP) under the Affordable Care Act (ACA). The ACA permits individuals and small businesses to purchase private health insurance through Health Insurance Marketplaces; section 1311(b)(1)(B) of the ACA… Continue Reading