news and updates
President Trump Signs Executive Order on the Affordable Care Act
On Inauguration Day, President Trump signed an Executive Order instructing his administration to “exercise all authority and discretion available . . . to waive, defer, grant exemptions from, or delay the implementation of” the Affordable Care Act (ACA) pending repeal...
HRSA Withdraws 340B Program Omnibus Guidance
Jan. 31, 2017: HRSA has withdrawn its 340B Program Omnibus Guidelines. HRSA's Office of Pharmacy Affairs (OPA) first issued the guidance, which would have dramatically restricted key elements of the program, in August 2015. OPA submitted the final version of the...
CMS Issues Interim Final Rule Establishing New Transparency Requirements for Dialysis Facilities Offering Premium Assistance
Following the release of a Request for Information in August, CMS issued an interim final rule on December 12 requiring dialysis facilities that offer premium assistance for individual market health plans, whether directly or through a third party, to educate patients...
340B Drug Discount Program
HRSA Office of Pharmacy Affairs Program Website Law and Guidance Section 340B of the Public Health Service Act Selected Critical Guidance NEW: Proposed OPPS Rule, 340B Excerpt (July 20, 2017) NEW: OPA Withdrawal of Omnibus Guidance (Jan. 2017) 340B Drug Pricing...
CMS Issues Anticipated Pass-Through Payment Proposed Rule
CMS issues proposed rule that would limit the ability of states to create new or increased pass-through payments to providers in their Medicaid managed care programs. In its final Medicaid managed care rule issued last spring, CMS had explicitly allowed states to...
CMS Issues First FAQs on Medicaid Managed Care Rule
On Nov. 10, 2016, CMS issued its first set of Frequently Asked Questions on the Medicaid Managed Care Final Rule published in May. For more information on the Final Rule and the latest explanatory guidance, see our Medicaid Managed Care Resources Page.
MACPAC Considers DSH Targeting
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...
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...
CMS Releases 2017 Medicaid Managed Care Rate Development Guide, but New Provider Payment Provisions Remain to be Addressed
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 provisions...
CMS Announced Final FY 2014 and Preliminary FY 2016 DSH Allotments
October 25, 2016: CMS issues notice announcing limit on the portion of federal dollars allocated to match state DSH hospital payments for the FY.
CMS Sends Medicaid Pass-Through Payment Proposed Rule to OMB
Oct. 19, 2016: CMS submitted to the Office of Management and Budget for review a proposed rule that would presumably limit the ability of states to create new or increased pass-through payments to providers in their Medicaid managed care programs. The agency...
HRSA Submits 340B Omnibus Guidance for Review
September 1, 2016: The 340B Omnibus Guidance notice is back at the Office of Management and Budget for review before issuance, just over a year after publication of the proposed version of the notice.
CMS Publishes Request for Information Expressing Concern with Premium Assistance
August 23, 2016: CMS Publishes Request for Information Expressing Concern with Premium Assistance Arrangements that Steer Patients from Medicare and Medicaid into Marketplace Plans
CMS Proposes Rule to Codify Medicaid DSH Limit
August 12, 2016: CMS Proposes Rule to Codify Medicaid DSH Limit Policy Currently the Subject of Federal Lawsuits
HRSA Proposes Dispute Resolution Process for 340B Discount Program
August 11, 2016: HRSA Proposes Dispute Resolution Process for 340B Discount Program
CMS releases guidance on Pass-Through Payments in Medicaid Managed Care
July 29, 2016: CMS releases guidance on Pass-Through Payments in Medicaid Managed Care
CMS Releases Medicare Hospital Star Ratings
July 27, 2016: CMS Releases Medicare Hospital Star Ratings
CMS Proposes Mandatory Medicare Bundled Payment for Cardiac Care
July 25, 2016: CMS Proposes Mandatory Medicare Bundled Payment for Cardiac Care