On August 13, 2019, the D.C. Circuit issued its highly-anticipated decision in a lawsuit brought by the Children’s Hospital Association of Texas (CHAT) and others, challenging the legality of CMS’ 2017 Medicaid DSH third-party payer final rule that was set […]

On June 24, 2019, President Trump issued an executive order on price and quality transparency, requiring the Department of Health and Human Services and the Secretary of the Treasure to issue a variety of proposed regulations and guidance within 60 […]

In its June 2019 report to Congress on Medicaid and CHIP, the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended that Congress modify the Medicaid shortfall portion of the disproportionate share hospital (DSH) limit calculation to exclude costs and […]

On May 1, 2019, CMS released a request for information to solicit ideas for developing a “State Relief and Empowerment Waiver” plan. The RFI is part of the Administration’s effort to offer states options for implementing alternative approaches to their […]

On April 24, 2019, CMS released a letter to state Medicaid directors describing three opportunities for states to improve care integration for Medicaid and Medicare dually eligible beneficiaries: 1) increased flexibility under the Medicaid Financial Alignment Initiative’s capitated financial alignment […]

On April 23, 2019, CMS released its proposed Medicare inpatient prospective payment system rule for FY 2020, proposing significant changes to the wage index to improve access to care in rural areas, as well as several new policies to promote […]

On April 22, 2019, HHS unveiled new Medicare pilot projects that would encourage primary care providers to take on greater financial risk and support providers that focus on high-need patients with chronic illnesses. The pilots are voluntary, five-year projects that will be administered […]

On April 1, 2019, the Health Resources and Services Administration implemented its long-delayed final rule on 340B ceiling price transparency, releasing a database reporting the maximum price drug manufacturers may charge covered entities for 340B drugs. Several hospital groups had filed a lawsuit to force HRSA […]

On March 18, 2019, MACPAC published its recommendations for restructuring the Medicaid disproportionate share hospital (DSH) program. In its March 2019 Report to Congress, MACPAC outlined three recommendations for minimizing the impact of DSH cuts on safety net hospitals: 1) Gradually phase in reductions […]

As of December 30, 2018, CMS has withdrawn its policy on the inclusion of third party payments in calculating the disproportionate share hospital (DSH) limit. FAQs 33 & 34 require that states include commercial and Medicare payments, respectively, in their DSH limit […]