CMS approves new 10-year TennCare III waiver
On January 8, 2021, CMS approved a new 10-year TennCare III waiver establishing a fixed aggregate dollar cap on funding accompanied by increased flexibility to make program changes and an opportunity for shared savings.
CMS Releases Revised Managed Care Directed Payments Preprint Application
On January 8, 2021, CMS published a revised managed care directed payment preprint application as part of its new guidance on directed payments released the same day. The revised preprint incorporates additional questions and more detailed tables, many of which had...
CMS Releases New Guidance on Managed Care Directed Payments
On January 8, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) outlining additional guidance on Medicaid managed care directed payments, as well as a revised preprint form for use in seeking approval of...
CMS Requests States’ Signature of 1115 Waiver Agreement
On January 4, 2021, CMS requested that states with 1115 waivers sign a Letter of Agreement establishing restrictive procedural requirements for CMS to terminate their waivers.
HRSA Issues Advisory Opinion Concluding the 340B Statute Requires Discounts When Drugs Are Dispensed Through Contract Pharmacies
Following a series of disputes between drug manufacturers and participants in the 340B program over contract pharmacies, on December 30, 2020, the Health and Resource Service Administration (HRSA) issued Advisory Opinion 20-06, concluding that the plain meaning of the...
CMS Approves 1-Year Extension of CA 1115 Waiver Demonstration
On December 29, 2020, the Centers for Medicare & Medicaid Services (CMS) approved California’s request to extend its 1115 waiver demonstration, “Medi-Cal 2020,” for one year. Medi-Cal 2020 was approved for a five-year period on December 30, 2015, building off...
Congress Requires HHS to Establish Process for Reporting on Medicaid Supplemental Payments
In the Consolidated Appropriations Act of 2021 (CAA), Congress enacted a provision requiring the Department of Human Services (HHS) to establish a mechanism for reporting on Medicaid supplemental payments. The reporting requirements will apply to supplemental payments...
Congress Delays and Reduces DSH Allotment Cuts, Alters Treatment of Patients with Third-Party Coverage in Calculating the Hospital-Specific DSH Limit
The Consolidated Appropriations Act of 2021 (CAA) contains two important changes impacting Medicaid disproportionate share hospital (DSH) payments. First, the CAA once again delays Medicaid DSH cuts mandated by the Affordable Care Act, extending $8 billion in annual...
HRSA Publishes Alternative Dispute Resolution Final Rule
On December 14, 2020, the Health and Resource Service Administration (HRSA) published a Final Rule specifying the requirements and procedures for the 340B Program's administrative dispute resolution (ADR) process. The process was established to support covered...
Hospital Associations File Lawsuit Against HHS to Spur Enforcement of 340B Contract Pharmacy Discounts
Six national associations representing hospitals and pharmacists, and three individual hospitals participating in the 340B drug discount program, filed a lawsuit in the Northern District of California asking the court to order the Health and Resource Service...
CMS Issues Medicaid Managed Care Final Rule
On November 9, 2020, CMS issued a managed care rule that largely finalizes policies proposed by the agency in a November 2018 proposed rule. Among other things, the final rule would eliminate prior approval requirements for directed payments implementing minimum fee...
CMS Announces Withdrawal of MFAR
On September 14, 2020, CMS administrator Seema Verma issued a tweet announcing that the agency was withdrawing the Medicaid Fiscal Accountability Rule (MFAR) from the regulatory agenda. The rule was initially released in November 2019 and remains in proposed form.
HHS to Distribute Provider Relief Funding to Medicaid/CHIP and Safety Net Hospitals
On June 9, 2020, HHS announced an additional $15 billion distribution from the CARES Act Provider Relief Fund to Medicaid and CHIP providers. Specifically, the funds will be allocated to eligible providers who have not yet received a distribution from the General...
CMS Releases Proposed IPPS Rule for 2021
On May 11, CMS released its Proposed Inpatient Prospective Payment Rule for FY 2021. The rule includes revisions to hospital payments and quality reporting requirements.
Fifth Circuit Upholds CMS Third Party Payer Rule in DSH Litigation
On April 20, The U.S. Court of Appeals for the Fifth Circuit became the third appeals to court to reinstate CMS' 2017 final rule requiring states to include Medicare and commercial payments in their Medicaid DSH limit calculations. The rule was recently reinstated on...
HHS Delivers First $30 Billion of CARES Act Funding
On April 10, 2020 CMS announced its delivery of the first $30 billion tranche of provider relief funding as part of the $100 billion CARES Act fund.
Petition for Certiorari Filed in CHAT DSH Litigation
On April 6, 2020, a petition for writ of certiorari was filed in the DSH litigation case of Children's Hospital Association of Texas v. Azar.
Coronavirus Resources
This page collects some of the COVID-19-related federal laws, regulations and guidance that is most relevant to Eyman Associates’ clients and friends. Please feel free to reach out to any of our team members to help you navigate these complex policies during this...