Beyond Hospice: And They’re Off! The OIG’s Nationwide Review of Hospice Eligibility Has Begun
Podcast: Non-binding Guidance: Breakthrough Devices Program
On August 8, a coalition of 15 state attorneys general sued CMS in the North Dakota federal court seeking to overturn a May 2024 CMS final rule making Deferred Action for Childhood Arrivals (DACA) recipients eligible for...more
For skilled nursing facility residents applying for long-term care Medicaid benefits, under federal regulation, all state agencies are required to issue an eligibility determination on the application within 45 days of the...more
In our day-to-day work representing skilled nursing facilities, we are regularly asked by our clients to assist in securing Medicaid benefits for their residents. This often entails seeking the cooperation of the resident or...more
Apparently in light of recent litigation against Medicare Advantage (MA) plans, on February 6, 2024, CMS published responses to frequently asked questions (FAQs) regarding the use of algorithms and artificial intelligence in...more
In December 2022, the U.S. Congress took a step to address churn—where enrollees lose Medicaid coverage, often for procedural reasons, and later reenroll after a gap in coverage—in the Consolidated Appropriations Act, 2023...more
The No Surprises Act (NSA), enacted in 2020, protects patients from surprise medical bills for emergency services and, in certain circumstances, when treated by out-of-network providers in an in-network facility. Since the...more
As discussed here, D.K. et al. v. United Behavioral Health et al. is a case that has been carefully watched in the health benefits space for its impact on what health plan administrators must include in adverse benefit...more
Editor’s Note: In a new issue brief prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, Manatt Health reviews state Medicaid and Children’s Health Insurance Program (CHIP) agency…...more
Following the expiration of the Public Health Emergency (PHE), states will resume normal eligibility and enrollment activities for all enrollees in Medicaid and the Children’s Health Insurance Program (CHIP). The volume of...more
The crisis in immigrant health coverage has been both highlighted and exacerbated by the recent pandemic. COVID-19 has taken a heavy toll on immigrants, who are disproportionately frontline/service workers, making them...more
Two recent sets of guidance affecting employers’ operations of employee benefit plans have been issued by the Internal Revenue Service (the IRS) and the Department of Labor (the DOL). ...more
As a result of the ongoing COVID-19 pandemic, we are observing all sorts of never-before-seen changes in the fully-insured group health plan space. Many insurers are liberally waiving their normal rules to accommodate the...more
The Ohio Department of Insurance (ODI) has issued guidance pursuant to Governor Mike DeWine’s emergency declaration and March 9, 2020, order directing state agencies to implement procedures consistent with recommendations...more
A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan....more