Model Overview -
CMS as Negotiator -
Under the model, CMS will negotiate OBAs with participating manufacturers, which will tie pricing for SCD treatments to whether the therapy improves health outcomes for people with...more
We’ve written recently about the process that states are undertaking to begin to wind down the Medicaid enrollment expansion that was necessitated by the enactment of the Families First Coronavirus Response Act in March of...more
12/12/2023
/ Beneficiaries ,
Centers for Medicare & Medicaid Services (CMS) ,
Consolidated Appropriations Act (CAA) ,
Corrective Action Plans (CAPs) ,
Eligibility ,
Enrollment ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Medicaid ,
New Rules
At the onset of the COVID pandemic in March of 2020, Congress made an important policy decision: continued access to health coverage was crucial, especially because, at the time, it was uncertain how the economy would...more
9/19/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Due Process ,
Enrollment ,
Families First Coronavirus Response Act (FFCRA) ,
Health Insurance ,
Public Health ,
Redeterminations ,
SCOTUS ,
State Medicaid Programs
Hello readers! Today’s post focuses on a topic we’ve touched on a few times in the past – Medicaid drug formularies.
Back in December 2021, the state of Oregon released a draft Medicaid waiver proposal that caught the...more
3/1/2022
/ 1115 Waivers ,
Centers for Medicare & Medicaid Services (CMS) ,
Food and Drug Administration (FDA) ,
Managed Care Contracts ,
MDRP ,
Medicaid ,
Oregon ,
Patients ,
Prescription Drugs ,
Proposed Legislation ,
State and Local Government ,
Waivers
On November 6, 2021, the Fifth Circuit Court of Appeals temporarily blocked enforcement of the OSHA vaccination-or-testing rule. Citing “grave statutory and constitutional issues” with the rule, a three-judge panel issued the...more
11/8/2021
/ Anti-Discrimination Policies ,
Appeals ,
Centers for Disease Control and Prevention (CDC) ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Civil Rights Act ,
Coronavirus/COVID-19 ,
Enforcement ,
Equal Employment Opportunity Commission (EEOC) ,
Health Care Providers ,
Healthcare Workers ,
Interim Final Rules (IFR) ,
Order to Stay ,
OSHA ,
Religious Exemption ,
Title VII ,
Vaccinations ,
Virus Testing
Due to the COVID-19 pandemic, most people have spent considerably more time at home over the past year. For many, this meant long hours of Netflix binging, crossword puzzles, and the occasional zoom happy hour. But for some...more
On January 28th, President Biden issued an “Executive Order on Strengthening Medicaid and the Affordable Care Act.” The E.O. states that the Biden Administration will promote policies that “protect and strengthen Medicaid and...more
2/1/2021
/ Affordable Care Act ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Executive Orders ,
Final Rules ,
Medicaid ,
Open Enrollment ,
SCOTUS ,
Secretary of HHS ,
Trump Administration
On November 9, 2020, the Centers for Medicare and Medicaid Services (“CMS”) announced it finalized the Medicaid and Children’s Health Insurance Program (“CHIP”) Managed Care final rule (“2020 final rule”). According to CMS,...more
On August 4th, CMS released a proposed rule titled Treatment of Medicare Part C Days in the Calculation of a Hospital’s Medicare Disproportionate Patient Percentage (DPP). We’ve written before about the Medicaid...more
8/23/2020
/ Administrative Procedure Act ,
Azar v Allina Health Services ,
Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Medicaid ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part C ,
NPRM ,
Public Comment ,
Rulemaking Process ,
SCOTUS