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Medicaid › Reimbursements › Hospitals

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 -
Whiteford

California Department of Public Health's (CDPH) Limits On CRNA Scope of Practice Reminds Hospitals Nationwide to Revisit...

Whiteford on

The California Department of Public Health (CDPH) issued a letter on September 6, 2024, to all general acute care hospitals clarifying the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) following...more

ArentFox Schiff

The 2025 Proposed Hospital Outpatient Prospective Payment System and Physician Fee Schedule Rules: What Pharma Stakeholders Need...

ArentFox Schiff on

Pharma’s favorite summer pastime is back again: reviewing the Centers for Medicare & Medicaid Services (CMS) release of the 2025 proposed Hospital Outpatient Prospective Payment System (HOPPS) and Physician Fee Schedule (PFS)...more

ArentFox Schiff

Post-Chevron Health Care Regulations: The Dawn of a New Day

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On June 28, the US Supreme Court overturned the Chevron doctrine — the legal principle that the judiciary should defer to a federal agency’s reasonable interpretation of an ambiguous statute. Chevron reflected the view...more

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

American Conference Institute (ACI) on

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...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

Foley & Lardner LLP

“Acute Hospital Care at Home”: Omnibus Bill Extends Flexibility Period to December 31, 2024

Foley & Lardner LLP on

As part of the $1.7 million omnibus spending bill that became law December 29, 2022, the Centers for Medicare & Medicaid Services (CMS) extended, through December 31, 2024, the Acute Hospital Care at Home (H@H) initiative...more

McDermott Will & Emery

Hospital Reimbursement Opportunity Remains After CMS Decides Not to Finalize DSH Payment Calculation Changes

McDermott Will & Emery on

On December 17, 2021, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2022 inpatient prospective payment system (IPPS) final rule. In light of the significant volume of comments, CMS declined...more

Lathrop GPM

U.S. Supreme Court Hears Oral Arguments in Two Hospital Cases This Week

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This is a big legal week for hospitals and health systems as the U.S. Supreme Court heard not one, but TWO different oral arguments related to federal government payments to hospitals and health systems. In both cases, the...more

Latham & Watkins LLP

Healthcare & Life Sciences: Drug Pricing Digest - July 2021

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Drug Pricing Initiatives: Debate continues regarding the drug pricing measures pending in Congress. On June 22, 2021, Senate Finance Committee Chair Ron Wyden released legislative principles that, among other things, would...more

Manatt, Phelps & Phillips, LLP

[Webinar] Ten Health Care Imperatives for the Decade Ahead: Stabilizing the Safety Net - April 28th, 1:00 pm - 2:00 pm ET

Manatt, Phelps & Phillips, LLP on

Participate in a Discussion on Issues to Secure the Safety Net and Advance Equity at a New Manatt Webinar—the Third in Our Ongoing Health Care Imperatives Series... COVID-19 exposed the growing crisis faced by our safety...more

Baker Donelson

D.C. Court of Appeals Permits Hospitals to Include Inpatient Section 1115 Days in the Medicaid Fraction of the Medicare...

Baker Donelson on

The United States Court of Appeals for the District of Columbia recently ruled that a hospital's Medicaid eligible days in its Medicare disproportionate share hospital (DSH) calculation should include patients who receive...more

Davis Wright Tremaine LLP

2021 OPPS and ASC Payment System Final Rule: Change Is the Only Constant

Davis Wright Tremaine LLP on

On December 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the calendar year 2021 Final Rule implementing changes to the Medicare hospital Outpatient Prospective Payment System (OPPS) and Ambulatory...more

McDermott Will & Emery

CMS Proposes Further OPPS Reductions to 340B Drug Reimbursement Rates

McDermott Will & Emery on

On August 4, 2020, the Centers for Medicare & Medicaid Services (CMS) released its CY 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) proposed rule. CMS proposes to reduce OPPS payments for 340B drugs from...more

K&L Gates LLP

K&L Gates Triage: Looking Ahead to 2020: Developing Issues in Pharmacy Law and the 340B Drug Pricing Program

K&L Gates LLP on

In this episode, Ryan Severson and Victoria Hamscho discuss recent developments in pharmaceutical pricing and the 340B Drug Pricing Program heading into 2020, including reimbursement cuts for 340B drugs under the Outpatient...more

K&L Gates LLP

K&L Gates Triage: 340B Eligibility - Hospital Covered Entities

K&L Gates LLP on

This podcast focuses on the eligibility requirements for hospitals participating in the 340B Drug Pricing Program. Factors affecting eligibility include a hospital’s licensure status, patient population, and Medicare...more

Mintz - ML Strategies

Recent Developments in Massachusetts Health Policy

Mintz - ML Strategies on

Building on the momentum of early October hearings on the state’s growing health care expenditures, the Health Policy Commission (HPC), the Joint Committee on Health Care Financing, Governor Charlie Baker, and others spent...more

Foley & Lardner LLP

Changes to New York Telehealth Coverage Coming Soon

Foley & Lardner LLP on

After New York became the 22nd state to enact a telemedicine commercial coverage statute, Governor Andrew Cuomo signed an amendment changing the statute. The amendment makes sweeping changes to telehealth coverage under New...more

Faegre Drinker Biddle & Reath LLP

Suing the Hand that Feeds You

Faegre Drinker Biddle & Reath LLP on

Jeffrey Jacobs alleges that Idaho’s Pocatello Hospital violated the False Claims Act because of physician recruitment contracts that were overly generous to his practice group. Jeff should know because he was recruited under...more

BakerHostetler

Children’s Hospitals Obtain Temporary Injunction Against CMS

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Challenging actions by the Centers for Medicare & Medicaid Services (CMS) under the Administrative Procedures Act (APA), Texas Children’s Hospital and Seattle Children’s Hospital obtained a preliminary injunction that enjoins...more

Foley & Lardner LLP

Is Provider-Based Reimbursement Going Away?

Foley & Lardner LLP on

We get this question every year: will Medicare, Medicaid or other payors continue to recognize hospital-level facility fee reimbursement for hospital outpatient departments meeting the provider-based designation criteria at...more

Akin Gump Strauss Hauer & Feld LLP

Software Glitch Sparks FCA Suit Against Hospitals for Late Repayment of Medicaid Reimbursements

Akin Gump Strauss Hauer & Feld LLP on

On June 27, the New York Attorney General’s Office and the U. S. Attorney’s Office for the Southern District of New York intervened in a qui tam suit against Continuum Health Partners, Inc., Beth Israel Medical Center and St....more

BakerHostetler

Healthcare Providers Face Increasing Financial Pressure and Bankruptcy Risk

BakerHostetler on

The health of the healthcare industry can be summarized as follows: as go federal reimbursement rates, so goes the financial viability of healthcare providers, whether hospitals, nursing homes or medical practices. These...more

Akerman LLP - Health Law Rx

HHS Proposes Extension of Deadline for EHR Compliance

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According to the federal government, over 370,000 providers have participated in the Medicare and Medicaid Electronic Health Record ("EHR") incentive program since its inception in 2011. However, providers nationwide continue...more

BakerHostetler

Medicaid DSH: Little-Noticed CMS Rule Interpretation Creates Serious Financial Shortfalls for Impacted Hospitals

BakerHostetler on

In what may have been a largely unnoticed rule interpretation affecting hospitals that treat a high percentage of children in the Medicaid program, CMS, in January 2010, issued a response to a Frequently Asked Question (FAQ)...more

King & Spalding

DC Circuit Issues Latest DSH Decision, Reducing Reimbursements

King & Spalding on

On June 11, 2013, the D.C. Circuit Court issued the latest ruling relating to the proper calculation of hospitals’ disproportionate share hospital (DSH) payment, leading to potentially lower Medicare reimbursements related to...more

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