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CMS Proposes Fundamental Reimbursement Methodological Change for 340B Drugs...
We have noted before the link between the Medicaid prescription drug rebate program and the 340B program. As a refresher, in order to have its outpatient drugs covered by Medicaid, the manufacturer...
View ArticleMassachusetts Proposes to Dramatically Restructure Medicaid Benefits
On July 21, 2017, the Massachusetts Executive Office of Health and Human Services (“EOHHS”) announced its intent to submit a request to amend its existing MassHealth Section 1115 Demonstration to the...
View ArticleCMS Disproportionate Share Hospital Policy to Get Second Look by First Circuit
An appeal recently filed in the United States Court of Appeals for the First Circuit could give further clarity regarding the CMS’s ability to discount Medicaid DSH payments for hospitals that received...
View ArticlePartner Tom Barker Discusses Gov. Baker’s Bipartisan Approach to Health Care...
Gov. Charlie Baker testified with four other governors on Capitol Hill in the latest sign that he’s playing a role in the next phase of federal health care reform. Partner Tom Barker speaks with WBUR...
View ArticleBaker Administration Submits 1115 Waiver Request to CMS, Including Major...
On September 8, 2017, following the mandated 30-day public comment period, the Baker Administration concluded its review of the pending MassHealth Section 1115 Demonstration Amendment Request. The...
View ArticleCMS Issues New Guidelines on 1115 Waivers; Signals New Medicaid Objectives
On November 6, 2017 the Centers for Medicare & Medicaid Services (CMS) issued an information bulletin on changes and improvements to the existing Section 1115 waiver process.[1] Under Section...
View Article340B Hospitals File Suit in Wake of Hospital Outpatient Cuts
Back in July, my colleague Tom Barker told you about a CMS proposal to institute a fundamental reimbursement methodological change for 340B drugs used in the hospital outpatient setting. We have noted...
View ArticleEnforcing the Entitlement to Medicaid: The Ongoing Saga
We have written in the past about enforcing the entitlement to Medicaid through the federal court system. In light of a recent opinion by the United States Court of Appeals for the 8th Circuit, it...
View ArticleWebinar Presentation: The Ambitious MassHealth Shift to ACOs
Partner Tom Barker recently presented a webinar on the MassHealth shift to ACOs. Click here to view the presentation slides. Webinar Description The MassHealth program is embarking on a dramatic shift...
View ArticleFollowing on the Heels of Massachusetts, Arizona Floats New Medicaid Drug...
On November 17th, Arizona’s state Medicaid agency (the Arizona Health Care Cost Containment System, or AHCCCS) sent a letter to CMS proposing policies that it believes will build on past successes and...
View ArticleStarting Off The New Year With Work: How CMS’“Work and Community Engagement”...
We hope you enjoyed the holidays and New Year and are getting back into the swing of work. Speaking of work: Medicaid. We have previously covered on this blog (here) the Trump Administration’s...
View ArticleCMS to Phase Out Designated State Health Program (DSHP) Funding
On December 15, 2017, CMS Director Brian Neale informed State Medicaid Directors of CMS’ intent to phase out funding for Designated State Health Programs (DSHP) in Section 1115 waivers. CMS will no...
View ArticleMassHealth Leads The Way Towards Addressing Cell and Gene Therapy Reimbursement
Since August, 2017, a new class of transformative therapies referred to as cell therapies or gene therapies have been approved by the US Food and Drug Administration (FDA). These new cell and gene...
View ArticleCome see us at AHLA!
On March 21 and 22, two of this blog’s authors will be presenting on two Medicaid topics at the American Health Lawyer’s Association (AHLA) annual Medicare and Medicaid conference in Baltimore,...
View ArticleTrump Administration Outlines Priorities For FY 2019
The past couple of weeks have involved a flurry of healthcare-related developments, including on the Medicaid drug pricing front. On February 9, 2018, President Trump signed into law the Bipartisan...
View ArticleCMS Approves More Medicaid Work Requirements and Even More States Submit...
We’re certain that no one has forgotten about the January CMS policy announced by the current administration that supports states seeking to adopt work and community engagement requirements as part of...
View ArticleBlogging Live from AHLA: A Review of Recent Trends in Medicaid Waivers
Good morning from snowy Baltimore! Myself, along with my colleagues Tom Barker, Sean Ahern, and Erik Schulwolf are excited to be here here at AHLA’s Institute on Medicare and Medicaid Payment Issuers....
View ArticleBlogging Live from AHLA: Calder Lynch on the Medicaid Program
During the opening session of AHLA yesterday, we had the opportunity to hear remarks for Calder Lynch, current Counselor to CMS Administrator Seema Verma and potential replacement pick for outgoing...
View ArticleBlogging Live from AHLA: Enforcing the Medicaid Entitlement
My colleague Tom Barker and (my former boss) Professor Sara Rosenbaum just finished a series of back-to-back sessions on enforcing the Medicaid entitlement – the sessions were entertaining and engaging...
View ArticleBlogging Live from AHLA: Medicaid Litigation Update – Challenges to Waivers
Reporting live from the American Health Lawyer’s Association 2018 Institute on Medicare and Medicaid Payment Issues in Baltimore, MD, we are back again. This time, we are reporting on a deeply...
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