On January 30, 2020, CMS released a letter to state Medicaid directors outlining the agency’s block grant initiative titled “Healthy Adult Opportunity.” CMS will allow states to pursue either an aggregate cap or per-capita-cap approach to managing their Medicaid programs. The block […]

On January 27, 2020, the Governmental Accountability Office (GAO) released a report on the Medicaid 340B Drug Discount Program, particularly how the 340B program intersects with the Medicaid Drug Rebate Program. The GAO argued that a lack of transparency and documentation results […]

On January 8, 2020, the Centers for Medicare and Medicaid (CMS) issued an informational bulletin outlining a series of best practices for states to consider for avoiding duplicate discounts in the 340B program. According to CMS, the guidance is in […]

On December 2, 2019, the Texas Health and Human Services Commission filed suit against HHS seeking reversal of an August 2018 DAB decision that upheld a $25 million disallowance against the state. The complaint, filed in D.C District Court, argues […]

On Friday November 15, the Trump administration released a set of rules aimed at increasing transparency in the hospital and health insurance industries. A proposed rule targeting both exchange and employer-sponsored health plans would require insurers to disclose their negotiated […]

On November 12, 2019, CMS issued a proposed rule that, if finalized, would have a sweeping impact on Medicaid programs across the country. The 222-page “Medicaid Fiscal Accountability Regulation” seeks to implement significant policy changes to some of the key financing sources […]

On November 1, 2019, CMS issued its FY 2019 Outpatient Prospective Payment Systems (OPPS) Final Rule.

Federal district courts in Washington, New York, and California have blocked the Trump Administration’s public charge rule from going into effect. The Southern District of New York’s ruling applies on a nationwide basis, with the other two rulings limited to the […]

On October 9, 2019, President Trump issued an executive order on agency reliance on informal guidance documents. The order seeks to curb what the Administration believes to be a “back-door” practice of regulation that allows agencies to improperly bypass the […]

On October 9, 2019, the Trump administration released two proposed rules seeking to revamp current fraud and abuse regulations to support the transition to value-based payment. The first would amend regulations implementing the anti-kickback statute and civil monetary penalty law […]