As of December 30, 2018, CMS has withdrawn its policy on the inclusion of third party payments in calculating the disproportionate share hospital (DSH) limit.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 […]

On December 27, 2018, the United States District Court for the District of Columbia granted plaintiff hospitals’ motion to permanently enjoin HHS’ nearly 30% cut to certain 340B drugs. The Court held that in implementing its Medicare Part B rate reduction, the […]

On November 29, 2018, the Health Resources and Services Administration (HRSA) confirmed the effective date of its final rule on the 340B Drug Pricing Program. The rule institutes new ceiling prices on 340B drugs and authorizes monetary penalties against drug […]

On November 14, 2018, in a 2-1 decision, the 6th Circuit affirmed a summary judgment ruling that CMS Medicaid DSH third party payer FAQs are procedurally invalid, while holding that CMS has the statutory authority to require the inclusion of Medicare and commercial […]

On November 13, 2018, CMS notified state Medicaid directors of a new 1115 waiver opportunity for adults and children with serious mental health conditions. This new authority, similar to the agency’s substance use disorder waiver authority issued in November 2017, will allow states to […]

On November 8, 2018, CMS released proposed regulations to amend the 2016 Medicaid Managed Care Rule. The proposed rule would allow states to establish new 3-year pass-through payments for populations transitioning into managed care, streamline the approval process for directed payments based […]

On November 2, 2018, CMS issued its Hospital Outpatient and Prospective Payment System (OPPS) final rule. Of particular note, the agency finalized the proposal to extend the reduced payment rate provided under Section 603 of the Bipartisan Budget Act of 2015 […]

Facing a legal challenge from the hospital industry, the Health Resources and Services Administration has proposed a January 1, 2019 effective date of a rule to establish a system to verify ceiling prices for 340B drugs, to provide web site […]

On October 22, 2018, CMS released guidance for states seeking to implement State Innovation Waivers. The guidance provides additional clarification on the requirements that must be met for CMS to approve a 1332 waiver, including application review procedures, pass-through funding […]

On September 27, 2018, the Supreme Court granted certiorari in Azar v. Allina Health Services, et al. The Court will hear arguments on whether HHS was required to go through notice and comment before implementing a rule that altered the Medicare reimbursement formula for […]