CMS Changes Requirements on State Process for Reducing Medicaid Provider Rates
On November 16, 2017, CMS issued additional guidance on the required review process when a state proposes to reduce reimbursement rates.The agency clarified that the analysis and monitoring procedures described in the regulations would no longer be required in various...
CMS Releases Guidance on Changes To 1115 Waiver Process
On November 6, 2017, CMS released two information bulletins describing changes the agency will implement to streamline the waiver approval process. Changes will include clarification on certain procedural expectations (e.g. budget neutrality) to improve transparency...
CMS Releases Final Physician Fee Schedule Rule For CY 2018, Cutting Rates For Non-Grandfathered Off-Campus Provider-Based Departments
In its Physician Fee Schedule Final Rule for CY 2018, released November 2, 2017, CMS reduced the rates that will be paid for nonexcepted items and services furnished by nonexcepted off-campus provider-based departments (PBDs) for CY 2018. In CY 2017, CMS based...
CMS Releases Guidance on Direct Payments To Providers Under Managed Care
CMS released additional guidance to states on development and approval of “directed payments”—payments that the state directs its managed care plans to make to identified classes of providers through their managed care contracts. CMS newly defined this concept in its...
CMS Finalizes Medicaid DSH Regulations Regarding Treatment of Medicare and Commercial Payments for the Dual Eligibles
The Centers for Medicare & Medicaid Services (CMS) finalized regulations requiring states to include Medicare or commercial payments for services provided to dually eligible Medicaid patients when calculating the hospital-specific limit on DSH payments during...
HRSA Delays Rule on Determination of 340B Ceiling Prices and Manufacturer Penalties for Overcharging Providers
HRSA furthered delayed implementation of a final rule codifying the calculation of the 340B ceiling price, and implementing civil monetary penalties for manufacturers that knowingly and intentionally overcharge 340B providers. The final rule had been published on...
House Chip Bill Includes 2-year delay in Medicaid DSH
The House CHIP re-authorization bill would delay cuts in Medicaid disproportionate share payments to hospitals for two years. It is currently making its way through the rules committee and is anticipated to go to the House Friday, November 3rd.
Lawmakers Sign Bipartisan Letter to delay DSH Cuts
Over 220 Republican and Democratic lawmakers signed a letter to House leaders urging them to delay cuts to Medicaid disproportionate share hospital payments.
GOP Senators Release New ACA Repeal Bill Prior to Reconciliation Lapse
In a final effort prior to the expiration of their budget reconciliation bill on September 30th, Republican senators Lindsey Graham (SC) and Bill Cassidy (LA) have introduced a new proposal to repeal the Affordable Care Act. The plan would terminate the ACA's Medicaid...
CMS Proposes 27% Cut to Part B Payments for 340B Covered Drugs
In its proposed rule implementing changes to the Medicare Outpatient Prospective Payment System, CMS has proposed to reduce payments to hospitals for separately payable drugs that are eligible for discounts under the 340B Drug Pricing Program. Specifically, CMS would...
Eyman Associates Releases Analysis of Ongoing Medicaid DSH Litigation
Click here for the analysis.
CMS Posts Changes to Waiver Budget Neutrality Policy
CMS has posted on its website a presentation from May 2016 announcing significant changes to its budget neutrality policy for Section 1115 demonstrations. The policy could restrict states' abilities to continue or newly implement Medicaid provider payment programs or...
CMS Announces “Targeted” Discretion in Enforcing Medicaid Managed Care Rule Deadlines
On June 30, CMS issued an Informational Bulletin announcing that it will use "targeted" enforcement discretion to work with states that are unable to meet the Medicaid managed care rule's original deadlines for compliance, particularly those rules that take effect for...
Senate Adds Continuous Coverage Provision to “Better Care Reconciliation Act”
On June 26th, the Senate released a new version of its health reform repeal and replace bill, the Better Care Reconciliation Act, that would impose a six month waiting period to begin coverage for people with significant breaks in coverage during a year. The initial...
Congressional Budget Office Releases Score of Senate “Better Care Reconciliation Act”
On June 26, the CBO released its score of the Senate's version of the repeal and replace act, the "Better Care Reconciliation Act." According to the CBO, the Senate bill would save roughly $321 billion over 10 years--$202 billion more than the House’s American Health...
Senate Releases Discussion Draft of Health Reform Bill
On June 22, 2017, the Senate released a discussion draft of its version of the House's "American Health Care Act." The Senate's "Better Care Reconciliation Act of 2017" includes many of the provisions of the House bill, including significant cuts to the Medicaid...
CMS Issues Tool for 1332 Waivers in Effort to Stabilize 2018 Insurance Markets
On May 16, CMS released a 1332 Innovation Waiver Checklist intended to assist states in seeking waivers of Affordable Care Act requirements to allow for the establishment of high-risk pools and state operated reinsurance programs. CMS hopes the new tool will help...
HRSA Opts to Delay 340B Ceiling Price and Manufacturer Overcharging Penalty Rules until October 1, 2017
HRSA issued a rule further delaying until October 1, 2017, the implementation of a January 5th final rule codifying the calculation of the 340B ceiling price, and implementing civil monetary penalties for manufacturers that knowingly and intentionally overcharge 340B...