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 […]
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 […]
In its proposed rule implementing changes to the Medicare Outpatient Prospective Payment System, CMS has proposed to reduce payments to hospitals for separately payable drugs that are eligible for discounts under the 340B Drug Pricing Program. Specifically, CMS would reduce […]
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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 […]
On April 28, CMS issued its proposed rule for Medicare’s inpatient prospective payment system (IPPS) for federal FY 2018. Among its provisions, CMS announced its proposal to phase in use of Medicare cost report data to determine the allocation of […]
October 27, 2016: At its October meeting, the Medicaid and CHIP Payment and Access Commission (MACPAC) considered policies to improve targeting of Medicaid Disproportionate Share Hospital (DSH) payments, with respect to both hospitals and states, but did not come to […]
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 […]
Oct. 27, 2016: CMS has issued its Medicaid Managed Care Rate Development Guide for rating periods starting between January 1, 2017 and June 30, 2017. A number of critical provisions from the new regulations, including provisions related to special contract […]
October 25, 2016: CMS issues notice announcing limit on the portion of federal dollars allocated to match state DSH hospital payments for the FY.