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Reimbursement

Favorable Rulings Continue in Ongoing DSH Litigation, Now With Nationwide Impact and Several Appellate Court Decisions

Over the last several years, courts in various jurisdictions have issued favorable rulings in lawsuits challenging the Centers for Medicare & Medicaid Services’ (CMS’) policy requiring the inclusion of Medicare and commercial payments in the calculation of the Medicaid disproportionate […]

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CMS Finalizes Medicaid DSH Regulations Regarding Treatment of Medicare and Commercial Payments for the Dual Eligibles

The Centers for Medicare & Medicaid Services (CMS) finalized regulations requiring states to include Medicare or commercial payments for services provided to dually eligible Medicaid patients when calculating the hospital-specific limit on DSH payments during annual DSH audits. For some […]

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CMS Posts Changes to Waiver Budget Neutrality Policy

CMS has posted on its website a presentation from May 2016 announcing significant changes to its budget neutrality policy for Section 1115 demonstrations.  The policy could restrict states’ abilities to continue or newly implement Medicaid provider payment programs or other innovations.  Eyman Associates will […]

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CMS Approves All-Payer ACOs and a New Take on Medicaid Delivery System Reform Investment in Vermont

Oct. 24, 2016: CMS has approved Vermont’s Medicaid 1115 demonstration program, an important component of the state’s all-payer Accountable Care Organization (ACO) model. The initiative, which also has received funding from the CMS Center for Medicare and Medicaid Innovation, seeks […]

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