news and updates
Supreme Court Agrees to Hear $4B Medicare DSH Case
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...
Trump Administration to Consider Medicaid and Other Public Programs to Assess Public Charge
On September 22, 2018, the Trump administration issued a proposed rule that would newly consider an immigrant's use of Medicaid, SNAP, Medicare Part D Low-Income Subsidy program and several housing programs to determine whether an individual is a "public charge" for...
CMS issues SMDL Letter on Budget Neutrality Calculation for 1115 Waivers
On August 22, 2018, CMS issued a State Medicaid Directors letter outlining how states should calculate their budget neutrality expenditure limits for Medicaid 1115 Waivers.
CMS Issues Proposed Rule to Restructure the Medicare Shared Savings Program
On August 9, 2018, CMS released a proposed rule to restructure the Medicare Shared Savings Program (MSSP). The proposal seeks to reduce the amount of time ACOs can remain in the program without assuming risk by eliminating the one-sided shared savings option...
GAO Report Details Covered Entity Use of Contract Pharmacies and Related Compliance Issues, Including Audits and Corrective Action Plans
On June 28, 2018, the GAO released a report detailing how covered entities use contract pharmacies and relevant compliance issues.
CMS Releases New Medicaid Program Integrity Initiatives
On June 26, 2018, CMS announced a new set of initiatives seeking to promote program integrity throughout the Medicaid program. The initiatives focus on strengthening the audit process, increasing oversight of state contracts with provide health plans, increasing...
Trump Administration Releases Blueprint to Lower Drug Prices
On May 11, 2018, President Trump and HHS Secretary Alex Azar introduced their "American Patients First" initiative, described as a blueprint to lower drug prices and reduce out-of-pocket costs for patients. The plan also included a request for information (RFI)...
CMS Releases RFI on Stark Law
On June 25, 2018, CMS published a request for information (RFI) to seek input on how the agency could address the "undue regulatory impact and burden" of the physician self-referral, or "Stark," law.
CMS Rejects Kansas’ Request to Impose Lifetime Limits on Medicaid Beneficiaries
On May 7, 2018, CMS official Seema Verma announced that the agency would not approve Kansas’ request to impose a 3-year lifetime limit on certain Medicaid beneficiaries. Verma stated that while CMS is committed to transitioning people out of poverty, "we also...
CMS Publishes IPPS Extension for FY 2018
On April 26, 2018, CMS published an extension of the hospital Inpatient Prospective Payment Systems (IPPS) payment adjustments, effective April 24, 2018.
GAO Releases Report on CMMI Models
On April 25, 2018, GAO released a report on the performance results of various models implemented by CMS Innovation Center. The Report found that the models met goals targeting delivery and payment improvements, but only partially met the goals of reducing overall...
CMS Files Appeal to 8th Circuit on Final Rule in DSH Lawsuit
On April 10, 2018, CMS filed a notice of appeal to the 8th Circuit in the litigation of Missouri Hospital Association v. Price. This will be the first appellate court to hear arguments on the April 2017 Final Rule. It follows a First Circuit ruling earlier this month...
DC District Judge Vacates Medicaid DSH Third Party Payer Final Rule
On March 2, 2018, DC District Judge Emmet Sullivan ruled in favor of hospital plaintiffs and vacated a final rule promulgated by CMS requiring the inclusion of Medicare and commercial payments in the calculation of the Medicaid disproportionate share hospital (DSH)...
President’s FY 2019 HHS Budget Proposal Includes Significant Medicaid, Medicare and 340B Changes
The President’s FY 2019 budget includes several widely-reported health care proposals, such as an additional attempt at repealing and replacing the Affordable Care Act, as well as efforts to reduce the cost of prescription drugs and combat the opioid epidemic. But...
Missouri Federal Court First to Enjoin Implementation of Medicaid DSH Third Party Payer Final Rule
On Friday, February 9th, a federal district court in Missouri became the first to enjoin implementation of the Centers for Medicare & Medicaid Services’ (CMS’) Final Rule requiring the inclusion of Medicare and commercial payments in the calculation of the...
Congress Passes 2-year Delay of DSH Cuts
On February 9th 2018, Congress passed an extensive 2-year budget deal that included a delay to the scheduled DSH cuts until 2020. The bill contained additional health care measures, such as funding to combat the opioid epidemic and technical changes to MACRA (Medicare...
Indiana Becomes Second State to Add Work Requirements Among Other Changes
On February 2nd, Indiana become the second state to implement work requirements as part of its 1115 Medicaid Waiver, "Healthy Indiana Plan." The initiative mirrors Kentucky’s in its program requirements and the types of beneficiaries that are exempted from this new...
Kentucky Plaintiffs Challenge State Medicaid Work Requirements
On January 24, 2018, a group of 15 Kentucky Medicaid beneficiaries filed a complaint in D.C. District Court challenging HHS approval of Governor Bevin’s proposal to implement work requirements in Kentucky’s Medicaid program. The approval comes in the midst of new...