Value-based health care: issues for pharmaceutical companies
The Centers for Medicare & Medicaid Services (CMS) published two significant updates to its Medicaid regulations on May 10, 2024. The two Final Rules, a Medicaid Access Rule and a Medicaid Managed Care Rule, impose new...more
The New York Department of Health (DOH) announced March 8 that the 2022-2023 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual is available....more
An audit by the New Jersey Office of the State Comptroller (OSC) found that John Gore, a licensed drug and alcohol counselor, improperly billed and received over $1 million in Medicaid payments for services provided between...more
Medicaid providers and suppliers have likely discovered this the hard way. A provider’s or supplier’s enrollment in the Medicaid program may be insufficient to assure that their provision of a covered and medically necessary...more
The U.S. Supreme Court interpreted the Medicaid Act on June 6, 2022, to permit state Medicaid programs to recover costs for future medical care that has not yet been provided and may never be provided from Medicaid...more
Epstein Becker Green invites you to join former CMS Administrators Tom Scully, Leslie Norwalk, and Marilyn Tavenner for a unique panel discussion on their thoughts, advice, and predictions for President Biden’s newly...more
Yesterday (August 13), while in special session ordered by Gov. Bill Lee, the Tennessee General Assembly overwhelmingly passed an amended version of HB8002, which significantly enhances telehealth flexibility and payment...more
The U.S. Department of Health and Human Services (HHS) has begun the release of $30 billion of the $100 billion Public Health and Social Services Emergency Fund that is part of the Coronavirus Aid, Relief, and Economic...more
As with other states, in response to the COVID-19 pandemic and the guidance that the federal government has issued, Governor Abbott of Texas issued a disaster declaration on March 13, 2020 (the Disaster Declaration) resulting...more
This is the second article in our series addressing important topics for federally qualified health centers (FQHC) and the providers who work with them. Our first post in the series offered five tips for contracting with...more
In a significant break from preceding court decisions, the United States District Court for the District of Columbia recently struck down CMS's "must bill" policy, which requires that Medicare providers bill Medicaid and...more
The Florida Agency for Healthcare Administration (“AHCA”) has added a condition of Medicaid enrollment for behavior analysis services. Behavior analysis providers use applied behavior analysis to assist children with autism...more
Yesterday (December 11, 2018), the House passed H.R. 7217, the Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act. The Senate is expected to vote on the IMPROVE Act sometime next week. A...more
A recent report issued by the U.S. Department of Health & Human Services, Office of Inspector General (OIG), entitled “Ohio Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries’ Deaths,” found...more
State Medicaid Agencies have historically engaged in an epic balancing act. Federal law requires State Medicaid Agencies to ensure beneficiaries have access to medically necessary services. Federal law also requires State...more
As described in an April 17, 2018 article originally posted on the Sheppard Mullin Richter and Hampton, LLP False Claims Act Defense Blog, Kmart Corporation and the U.S. Department of Justice entered into a False Claims Act...more
In the midst of the ongoing federal conversation surrounding the 340B Drug Pricing Program, individual states are implementing a number of regulatory efforts related to the 340B Program at an increasingly fast pace. These...more
The Ninth Circuit held August 7 that the Department of Health and Human Services Secretary erred in approving a Medicaid State Plan Amendment (SPA) that cut reimbursement for outpatient hospital services in California by 10%...more
The U.S. Court of Appeals for the Ninth Circuit Court raised the bar last week for what states must prove to establish that their Medicaid provider reimbursement rates are sufficient to ensure a robust network of providers...more
Last week the Centers for Medicare and Medicaid Services (CMS) issued Release No. 104 to Manufacturers and Release No. 180, which invalidated earlier agency releases addressing the treatment under the Medicaid drug rebate...more
HealthCare.gov plans an open enrollment pilot that will let consumers compare provider network breadth; new Medicaid enrollees reduce out-of-pocket spending on prescription drugs by nearly 60%; and Kansas’s Governor announces...more
In its April 25, 2016 Medicaid managed care final rule, the Centers for Medicare and Medicaid Services (CMS) provides a revised framework for determining how managed care plans should be paid by state Medicaid programs. A...more
Recent action by the Centers for Medicare and Medicaid Services (CMS) announces significant change in reimbursement methodology for high volume orthopedic surgical procedures in many markets nationwide. Affected stakeholders...more
The 340B Drug Pricing Program (340B Program), established by Section 602 of the Veterans Health Care Act of 1992, is administered by the Health Resources and Services Administration (HRSA) of HHS. The 340B Program requires...more
Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more