news and updates
Trump Issues Executive Order on Price and Quality Transparency
On June 24, 2019, President Trump issued an executive order on price and quality transparency, requiring the Department of Health and Human Services and the Secretary of the Treasure to issue a variety of proposed regulations and guidance within 60 to 180 days,...
MACPAC Provides Recommendations on DSH “Medicaid Shortfall” Calculation
In its June 2019 report to Congress on Medicaid and CHIP, the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended that Congress modify the Medicaid shortfall portion of the disproportionate share hospital (DSH) limit calculation to exclude costs and...
CMS Offers Flexibility to States Seeking to Minimize ACA’s Economic Burden
On May 1, 2019, CMS released a request for information to solicit ideas for developing a “State Relief and Empowerment Waiver” plan. The RFI is part of the Administration’s effort to offer states options for implementing alternative approaches to their insurance...
CMS Releases State Medicaid Director Letter on Integrated Care for Dual Eligibles
On April 24, 2019, CMS released a letter to state Medicaid directors describing three opportunities for states to improve care integration for Medicaid and Medicare dually eligible beneficiaries: 1) increased flexibility under the Medicaid Financial Alignment...
CMS releases proposed Medicare IPPS Rule
On April 23, 2019, CMS released its proposed Medicare inpatient prospective payment system rule for FY 2020, proposing significant changes to the wage index to improve access to care in rural areas, as well as several new policies to promote access to innovative...
HHS Announces Primary Care Payment Pilots
On April 22, 2019, HHS unveiled new Medicare pilot projects that would encourage primary care providers to take on greater financial risk and support providers that focus on high-need patients with chronic illnesses. The pilots are voluntary, five-year projects that...
HRSA Launches 340B Ceiling Price Database
On April 1, 2019, the Health Resources and Services Administration implemented its long-delayed final rule on 340B ceiling price transparency, releasing a database reporting the maximum price drug manufacturers may charge covered entities for 340B drugs. Several...
MACPAC Releases Recommendations on Medicaid DSH Cuts
On March 18, 2019, MACPAC published its recommendations for restructuring the Medicaid disproportionate share hospital (DSH) program. In its March 2019 Report to Congress, MACPAC outlined three recommendations for minimizing the impact of DSH cuts on safety net...
CMS Withdraws FAQs 33 & 34 Amidst Ongoing DSH Litigation
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...
Federal District Court Enjoins Medicare Part B Payment Cut for 340B Drugs
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 Agency...
HRSA Confirms 340B Final Rule Effective Date of January 1
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...
6th Circuit Affirms District Court Ruling On Medicaid DSH FAQs While Upholding Underlying Policy
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...
CMS Announces New Waiver Opportunity for Inpatient Mental Health Services
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,...
CMS Released Proposed Medicaid Managed Care Rule
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...
CMS Issues 2018 OPPS Final Rule
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 (BBA) to...
HRSA Proposes Earlier Effective Date for Long-Pending 340B Ceiling Price Rule
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 access to the ceiling...
CMS Approves Innovative Pilot Program to Address Social Determinants of Health as Part of North Carolina’s New Medicaid Waiver
For a printer-friendly version, click here. The Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 waiver for North Carolina on October 19, 2018 that includes an innovative new pilot program. Embedded in the larger waiver, which is focused...
CMS Releases Guidance on 1332 Waivers
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,...