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Medicaid › Fee-for-Service

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Holland & Knight LLP

Fiscal Intermediaries Sue NYDOH Over CDPAP Reimbursement Changes

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A group of fiscal intermediaries (FIs) on July 22, 2024, filed a lawsuit against the New York State Department of Health (DOH) and its commissioner, Dr. James McDonald, alleging that the defendants disregarded established...more

Manatt, Phelps & Phillips, LLP

CMS Releases Technical Guidance to States on Complying with Medicaid Access Final Rule

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On July 12, CMS released a companion guide to the Ensuring Access to Medicaid Services final rule (the “Access Final Rule”). This technical guidance—which focuses on the provisions regarding fee-for-service (FFS) payment...more

Manatt, Phelps & Phillips, LLP

Designing a Medicaid Hospital Global Budget Under CMS’ AHEAD Model

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In September 2023, the Centers for Medicare and Medicaid Services (CMS) announced the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, and this week CMS is expected to make a first set of...more

Foley & Lardner LLP

Medicaid: CMS Final Rules Aim to Expand Access, Provide Parity with Commercial Markets

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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

Manatt, Phelps & Phillips, LLP

CMS Finalizes Sweeping Regulations for Medicaid Access, Managed Care, and HCBS

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On Monday, April 22, the Centers for Medicare & Medicaid Services (CMS) released two highly anticipated final rules. Together, these rules reshape the federal regulatory landscape for Medicaid and the Children’s Health...more

McDermott+

CMS Finalizes Major Reforms to Medicaid, Part 2: Medicaid Managed Care Reg

McDermott+ on

Medicaid Regs Part 2! Last week, Regs & Eggs took a deep dive into the Ensuring Access to Medicaid Services final reg, one of two regs that the Centers for Medicare & Medicaid Services (CMS) released to add new requirements...more

McDermott+

Policy Update - CMS Releases Final Rule: Medicaid Program; Ensuring Access to Medicaid Services

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On April 22, 2024 the Centers for Medicare & Medicaid Services (CMS) published the Medicaid Program; Ensuring Access to Medicaid Services final rule. The rule has a particular focus on home- and community-based services...more

Manatt, Phelps & Phillips, LLP

[Webinar] Final Medicaid Rules, Part Three: Home and Community Based Services - June 4th, 10:00 am - 11:00 am PT

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This program is part three of Manatt’s New Federal Rules on Medicaid Access and Managed Care webinar series. After releasing sweeping proposed rules on Medicaid access and managed care in spring 2023, the Centers for...more

Manatt, Phelps & Phillips, LLP

[Webinar] Final Medicaid Rules, Part Two: Managed Care Payments, Quality and Oversight - May 21st, 12:00 pm - 1:00 pm PT

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This program is part two of Manatt’s New Federal Rules on Medicaid Access and Managed Care webinar series. After releasing sweeping proposed rules on Medicaid access and managed care in spring 2023, the Centers for...more

Manatt, Phelps & Phillips, LLP

[Webinar] Final Medicaid Rules, Part One: Access, Enrollee Engagement and Provider Payment Transparency - May 14th, 12:00 pm -...

Manatt, Phelps & Phillips, LLP on

This program is part one of Manatt’s New Federal Rules on Medicaid Access and Managed Care webinar series. After releasing sweeping proposed rules on Medicaid access and managed care in spring 2023, the Centers for...more

King & Spalding

CMS Issues Final Rule Aimed at Improving Prior Authorization Processes

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On January 18, 2024, CMS released a pre-publication version of a final rule (the Final Rule) that will require Medicare Advantage organizations (MA or Part C), Medicaid and the Children’s Health Insurance Program (CHIP)...more

Harris Beach PLLC

Updated Medicaid Utilization Review Regulations from NYS Department of Health

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The New York Department of Health (DOH) adopted regulations effective on September 13, 2023, that revised Medicaid Utilization Review for Medicaid fee-for-service benefits. The regulations were initially published on April...more

Mintz - Health Care Viewpoints

Transforming Primary Care: CMS Launches Making Care Primary (MCP) Model

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The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model—the Making Care Primary (MCP) Model—geared towards smaller, independent primary care practices and organizations that want to participate...more

Manatt, Phelps & Phillips, LLP

[Webinar] Proposed Rules on Medicaid Payments, Access and Quality: Implications for Health Care Stakeholders - June 20th, 1:00 pm...

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On Thursday, April 27, the Centers for Medicare & Medicaid Services (CMS) released two highly anticipated proposed rules... Together, these would reshape the federal regulatory landscape for Medicaid and the Children’s Health...more

Manatt, Phelps & Phillips, LLP

[Webinar] Prenatal Vaccines in Medicaid & CHIP: Current State Payment Rates and Strategies to Increase Access - June 8th, 2:00 pm...

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Prenatal vaccines provide important protection for pregnant women and newborns against communicable diseases such as whooping cough and influenza. However, fewer than one out of four pregnant women receives all federally...more

Manatt, Phelps & Phillips, LLP

Prenatal Vaccines in Medicaid and CHIP: Coverage, Reimbursement, and State Policy Solutions to Increase Access

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Prenatal vaccines—those administered during a pregnancy—provide crucial protections to pregnant women and/or newborns against communicable diseases such as whooping cough and influenza. Additional prenatal vaccines are in...more

Manatt, Phelps & Phillips, LLP

The Pennsylvania Rural Health Model: Lessons Learned and What’s Next for Rural Payment Policies

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Since 2010, a reported 140 rural hospitals have closed their doors, including a record 19 hospitals in 2020 alone as a result of the financial pressures of COVID-19 compounded by many other long-standing challenges facing...more

Foley Hoag LLP

HHS Issues Report Outlining Three New Drug Models for Testing by CMMI

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On February 14, 2023, and in response to Executive Order 14087 (“Lowering Prescription Drug Costs for Americans”), the Secretary of Health and Human Services (HHS) issued a report announcing the selection of three models that...more

King & Spalding

CMS Proposes Rule to Require Certain Health Plans to Electronically Share Data with Providers Regarding Prior Authorization...

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On December 13, 2022, CMS is set to publish in the Federal Register a proposed rule (Proposed Rule) requiring certain Medicare, Medicaid, Children’s Health Insurance Program, and Qualified Health Plan fee-for-service and...more

Polsinelli

Minimum Wage Increase for Employees of Florida Medicaid Providers

Polsinelli on

On June 2, 2022, Governor DeSantis signed the “Freedom First Budget” for Fiscal Year 2022-2023 for the sole purpose of increasing the minimum wage for employees and independent contractors of Medicaid providers to at least...more

Manatt, Phelps & Phillips, LLP

CMS Solicits Input on Potential Medicaid and CHIP Reforms Around Eligibility, Enrollment and Access

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On February 17, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI) regarding the federal standards that govern access to care in Medicaid and the Children’s Health Insurance Program...more

Mitchell, Williams, Selig, Gates & Woodyard,...

Expiration of Arkansas' Public Health Emergency

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Since the COVID-19 public health emergency was initiated in Arkansas in March 2020, Governor Asa Hutchinson has repeatedly renewed the emergency order, maintaining the public health emergency for fourteen (14) months. ...more

Sheppard Mullin Richter & Hampton LLP

CMS to the Rescue for MA and Part D Plans – Rate Announcement Includes Significant Increase in Plan Payments for 2022

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Over the last year, we have seen volatility in the healthcare industry overall, and Medicare Advantage (“MA”) and Medicare Part D plans (together, “Plans”) have not been immune. Particularly because of their risk adjustment...more

Sheppard Mullin Richter & Hampton LLP

Medi-Cal Rx: California to Transition Medi-Cal Pharmacy Benefits to Fee-For-Service

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On April 1, 2021, the California Department of Health Care Services (“DHCS”) will be transitioning all Medi-Cal pharmacy benefits from managed care to fee-for-service (“FFS”). This new system to administer FFS pharmacy...more

Jackson Walker

CMS Expands List of Telehealth Services Covered by Medicare

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On October 14, 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the coronavirus disease 2019 (COVID-19) public health...more

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