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Medicaid › MCOs

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 -
McDermott+

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

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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 Will & Emery

New York State Budget Institutes Revenue-Neutral Health Plan Tax

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The New York State fiscal year 2024 – 2025 budget was signed on April 20, 2024, instituting, among many other provisions, a new tax on health plans, including insurers and managed care organizations. This tax has been...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

Bass, Berry & Sims PLC

CMS Finalizes CY 2025 Medicare Advantage Rule, Confirming Continued Focus on Marketing Practices and Health Equity

Bass, Berry & Sims PLC on

On April 4, the Centers for Medicare & Medicaid Services (CMS) issued the Contract Year (CY) 2025 Medicare Advantage (MA) Final Rule (Final Rule), which will have significant implications for MA plans and other industry...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

Mintz - Health Care Viewpoints

CMS Announces New Model for the Delivery of Integrated Behavioral and Physical Health Care

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With the goal of enhancing health care quality and outcomes for individuals with moderate to severe behavioral health conditions and substance use disorders (SUD), the Centers for Medicare & Medicaid Services (CMS) recently...more

Proskauer - Health Care Law Brief

Long Awaited Approval of the 1115 Waiver Amendment for NYS Medicaid – Just in Time for the New York State Executive Budget State...

Proskauer - Health Care Law Brief on

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently...more

Harris Beach PLLC

NYS DOH Seeks Grant Applications for Health Equity Social Care Networks

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The New York Department of Health (DOH) recently announced it is accepting applications for New York Health Equity Reform: Social Care Networks regional grants. The nine regional grants will distribute a total of $500 million...more

Harris Beach PLLC

New York OMIG Posts 2024 Work Plan

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On January 3, 2024, the New York State Office of the Medicaid Inspector General (“OMIG”) posted its 2024 Work Plan. This is the first update since its 2019 – 2020 Work Plan and OMIG notes that the Work Plan does not reflect...more

King & Spalding

OIG Publishes Strategic Plan for Managed Care Oversight on New Featured Webpage

King & Spalding on

On August 28, 2023, OIG released a new webpage on managed care oversight, which features the HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid. OIG has designated oversight of managed care as a...more

Holland & Knight LLP

Holland & Knight Health Dose: July 25, 2023

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. ...more

McDermott Will & Emery

Proposed Legislation Would Require Greater Transparency and Disclosure from Hospitals, Reduce Reimbursement to Certain Off-Campus...

McDermott Will & Emery on

Two bills are moving in the United States House of Representatives that have implications for hospitals and health systems, with material changes proposed regarding pricing transparency requirements, identification and...more

McDermott Will & Emery

HHS Takes Steps to Resolve 340B Medicaid MCO Duplicate Discount Confusion

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On May 26, 2023, the Centers for Medicare and Medicaid Services (CMS) proposed an update to the Medicaid Drug Rebate Program (MDRP) rules, which includes provisions aimed at preventing 340B duplicate discounts on claims...more

Manatt, Phelps & Phillips, LLP

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

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Editor’s Note: In a new white paper funded by Pfizer, Inc., Manatt Health discusses the current landscape of Medicaid and Children’s Health Insurance Program (CHIP) coverage and reimbursement for prenatal vaccines, informed...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

Manatt, Phelps & Phillips, LLP on

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

Harris Beach PLLC

New York Issues Technical Specifications Manual that Addresses Medicaid Payment Reporting

Harris Beach PLLC on

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

Rivkin Radler LLP

[Webinar] Lunch and Learn Series: OMIG's FINALIZED Regulations: What You Need to Do - NOW! - February 9th, 12:00 pm - 1:00 pm ET

Rivkin Radler LLP on

Please join us on February 9 as Partner Bob Hussar and Associates Ashley Algazi and Mary Connolly present on OMIG’s finalized regulations. On December 28th, the Office of Medicaid Inspector General (OMIG) released their...more

Foley Hoag LLP - Medicaid and the Law

Medicaid and the LawFoley Hoag LLP CMS Approves Two New Medicaid Waivers to Expand Coverage, Provide Flexibilities

Foley Hoag LLP - Medicaid and the Law on

On September 28, 2022, the Centers for Medicare & Medicaid Services (CMS) issued approval letters for Section 1115 Medicaid demonstration applications previously submitted by Oregon and Massachusetts. Section 1115 waivers...more

Manatt, Phelps & Phillips, LLP

Addressing Housing Insecurity via Medicaid Managed Care

Manatt, Phelps & Phillips, LLP on

With the prices of homes and rentals continuing to climb alongside already high rates of housing insecurity, access to basic, safe, and clean housing is at risk for many people with low incomes across the country. Recognizing...more

Mintz - Health Care Viewpoints

New York Office of Medicaid Inspector General Proposes Regulations on Medicaid Provider Compliance Programs

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The New York State Office of Medicaid Inspector General (OMIG) published proposed regulations in the July 13, 2022 issue of the New York State Register. The proposed regulations would repeal the current Part 521 - Provider...more

Manatt, Phelps & Phillips, LLP

OMIG Proposes Omnibus Regulations Impacting Medicaid Providers’ and Plans’ Compliance Obligations

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On July 13, 2022, the New York State Office of Medicaid Inspector General (OMIG) published proposed rules in the New York State Register to implement provisions of the State Fiscal Year 2020-2021 Enacted Budget and the...more

Manatt, Phelps & Phillips, LLP

[Webinar] In Pursuit of Whole-Person Health: A Review of Drivers of Health Initiatives in Medicaid Managed Care - July 25th, 1:00...

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Mounting evidence indicates that addressing the social and economic factors that drive the majority of health outcomes, often called social drivers of health (DOH), can improve health, promote health equity and reduce costs....more

Harris Beach PLLC

Advancing Medicaid Payment Reform, New York State Publishes Value Based Payment Reporting Requirements

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On May 26, the New York State Department of Health (“DOH”) published the 2022 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual, available on the DOH website. Value Based Payment (VBP) refers to...more

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