news and updates
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 Partners’ clients and friends. Please feel free to reach out to any of our team members to help you navigate these complex policies during this...
CMS Publishes COVID-19 FAQs for 340B Stakeholders
In March 2020, the Health Resources and Services Administration published a set of frequently asked questions (FAQs) for 340B stakeholders related to the COVID-19 pandemic. The FAQs address certain flexibilities and exemptions available to covered entities during the...
Drug Manufacturers File Independent Lawsuits in Response to 340B Advisory Opinion
After the Health and Resource Service Administration (HRSA) issued a December Advisory Opinion requiring 340B discounts for drugs dispensed through contract pharmacies, four drug manufacturers—Eli Lilly, AstraZeneca, Sanofi, and Novo Nordisk—have now filed four...
CMS Releases Guidance Allowing States to Pursue Block Grants for Certain Medicaid Populations
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...
GAO Releases Report on 340B Program, Urging More HHS Oversight on Duplicate Discounts
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...
CMS Issues Guidance on Avoiding Duplicate Discounts in 340B Program
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 response to...