news and updates
Congress Passes 6-Year CHIP Extension 114 Days After Funding Lapse
On January 22, 2018, the Senate passed a continuing resolution to reopen and fund the government through February 8, 2018. Included in the bill is a 6-year extension of the Children’s Health Insurance Program (CHIP). The final policy details surrounding the program...
CMS Approves Work Requirements in Kentucky Medicaid Program
On January 12, 2018, Kentucky became the first state to impose work requirements as a condition of Medicaid eligibility. The initiative, known as "Kentucky HEALTH," applies to non-disabled adults beneficiaries ages 19 to 64 and exempts former foster care youth,...
Work Requirements in 1115 Medicaid Waivers
CMS Work Requirements in 1115 Medicaid Waivers On January 11, 2018, CMS released guidance paving the way for states to obtain waivers to institute work requirements as a condition for Medicaid eligibility, a sharp deviation from prior CMS policy. This shift does not...
CMS Issues Guidance Allowing Work Requirements in Medicaid
On January 11, 2018, CMS released guidance supporting states seeking to condition Medicaid eligibility on a beneficiary’s participation in a community engagement, skill training, education, or job search initiative. CMS cited state requests for greater flexibility and...
House Releases Report on 340B Drug Program
On January 10, 2018, the House Energy and Commerce Oversight and Investigations Subcommittee released a report summarizing the results of a hearing on the 340B Drug Pricing Program and request for data from 340B covered entities, and making recommendations for program...
Hospitals appeal dismissal of lawsuit challenging Medicare rate reduction for 340B drugs.
On January 9, 2018, hospital groups filed an appeal to the D.C. District Court’s decision granting HHS’ motion to dismiss the lawsuit on Medicare rate reduction for 340B drugs.
2018: New Year, Ongoing Health Policy Challenges
Happy New Year from Eyman Partners to our clients and friends. The holiday break has given us a chance to pause and reflect on the year just finished and the challenges ahead. We wanted to share a few of our thoughts on issues we know are of concern to you, as they...
Estimated Cost of 5-Year CHIP Extension Lowered from $8 billion to $800 million
The Congressional Budget Office lowered its estimate of the costs of extending CHIP for five years under S. 1827 from $8 billion to $800 million due to the repeal of the Affordable Care Act’s individual mandate.
Judge Denies Motion for Preliminary Injunction in 340B Litigation
On December 29, 2017, Judge Rudolph Contreras of the DC District Court issued an order in the recent 340B program litigation, granting CMS’ Motion to Dismiss and denying provider-plaintiff’s’ Motion for Preliminary Injunction. This ruling authorizes CMS to move...
CMS Sends Letter to States on Phase-out of Special Federal Funding Mechanism in 1115 Waivers
On December 15, 2017, CMS notified state Medicaid directors that it will no longer accept state 1115 demonstration proposals that rely on funding for "Designated State Health Programs" (DSHP). While the agency acknowledged that federal DSHP funds were intended to...
CMS Releases Guidance on Implementation of Medicare Part B Rate Reductions for 340B Drugs
On December 13, 2017, CMS released guidance on its rate reduction for 340B drugs under Medicare Part B. The guidance confirms that beginning January 2018, Medicare will subtract 22.5% from the adjusted sales price when paying for 340B drugs furnished to a Medicare...
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.