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Tag Archives: Medicaid

Trump touts “historic” plan to overhaul Medicare payments, create International Pricing Index

President Trump today touted “bold” plans to lower drug prices in unspecific terms.  Simultaneously, CMS issued an Advance Notice of Proposed Rulemaking (ANRPM), describing options to test Medicare reimbursement based on an “International Pricing Index” (IPI), under which U.S. drug prices would be benchmarked against 16 other countries that reportedly have lower drug prices.  This

Florida Medicaid Announces Intention To Award Managed Care Program Contracts

Today the Florida Agency for Health Care Administration (AHCA) announced the names of the companies with which it intends to contract under the upcoming statewide Medicaid managed care program scheduled to be implemented by Fall 2014.  As part of a competitive procurement process, AHCA accepted competing bids from qualifying health plans across Florida’s 11 separate

CMS Releases Consumer Assistance Programs Final Rule

The Centers for Medicare & Medicaid Services (CMS) released a final rule on Friday, July 12th imposing requirements on various consumer assistance programs available to enrollees in Federally-Facilitated Exchanges (FFEs), State Partnership Exchanges, and to a more limited extent, State-run Exchanges. The final rule adopted conflict-of-interest, training and certification, and meaningful access standards applicable to

CMS Releases Medicaid Health Reform Final Rule

On July 5, 2013, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule, implementing provisions of the Patient Protection and Affordable Care Act (ACA) and the Children’s Health Insurance Program Reauthorization Act.  This rule finalizes provisions of the proposed rule, entitled “Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair

Miscellaneous Minimum Essential Coverage Provisions Final Rule

  The Department of Health and Human Services (“HHS”) released a final rule on June 26, 2013 addressing various aspects of the minimum essential coverage requirements imposed by the Affordable Care Act (“ACA”). Under the ACA, individuals must obtain and maintain health insurance that meets the definition of “minimum essential coverage” or face a tax

Obama Releases Budget Proposal

On April 10, 2013, President Obama released his Fiscal Year (FY) 2014 budget proposal.  As reported widely in the days leading up to the budget’s release, it included numerous health proposals that would together generate approximately $400 billion in savings over the next 10 years. Many of these proposals also appeared in the President’s FY

More Guidance on Medicaid Expansion Released by CMS

Enhanced Federal Matching Funds for the “Newly Eligible”:  On March 29, 2013, CMS released a final rule implementing the statutory increases in federal matching funds for the cost of providing care to individuals newly eligible for Medicaid via the expansion under PPACA.  Specifically, beginning in 2014, states will receive 100% federal matching funds for the

HHS Announces Medicaid Innovation Grants for 25 States

On February 21, 2013, HHS Secretary Sebelius announced that 25 states would receive State Innovation Model awards totaling nearly $300 million to help the states deliver high-quality care and lower costs for Medicaid recipients.  The largest grants are in the form of “Model Testing” awards given to Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont.  It

Florida’s Governor Scott Announces Support for Medicaid Expansion

Just hours after receiving the official word from CMS that it has agreed in principle to approve Florida Medicaid’s statewide mandatory managed care waiver, Governor Rick Scott appeared at a press conference to announce that he will urge the Florida Legislature in the upcoming session to approve an initial three-year Medicaid expansion under the Affordable

CMS Announces “Agreement in Principle” To Approve Florida Medicaid’s Statewide Managed Care Waiver

On February 20, 2013, Cindy Mann – the Director of CMS’s Center for Medicaid & CHIP Services – issued a letter to Florida’s Medicaid Director acknowledging the “significant progress” CMS and Florida Medicaid have made and the “agreement in principle” they have reached concerning Florida’s request to amend its section 1115 Medicaid demonstration project.  That

Affordable Care Act – Exemptions to the Individual Mandate

The Centers for Medicare & Medicaid Services (CMS) and the Internal Revenue Service (IRS) took another step towards implementing the controversial “individual mandate” imposed by the Affordable Care Act (ACA)—which is set to take effect on January 1, 2014—by jointly issuing two proposed rules to implement the exemptions to that mandate on January 30, 2013.

HHS Announces No Enhanced Federal Matching Funds for Partial Medicaid Expansion, But Still Finds Ways to Ease Administrative Burden and Costs for States

The Patient Protection and Affordable Care Act (ACA) made 100% federal matching funds available through Medicaid for states to provide health benefits to all non-pregnant, childless adults with incomes up to 133 % of the federal poverty level (FPL) starting in 2014 (“the ACA Medicaid expansion”).  Since the Supreme Court decision in National Federation of

CMS Releases Final Rules on Home Health, Primary Care and Dialysis Facility Payments

In a busy week leading up to the election, CMS released several final rules, including final rules pertaining to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS), Medicaid payments made to certain primary care physicians and the Home Health Prospective Payment System. ESRD PPS Final Rule In a final rule released on November 2nd, CMS

Seeing Green: CMMI Announces More Money for State Innovation

CMS’s Center for Medicare and Medicaid Innovation (CMMI) announced on July 19 $275 million in new federal grant money for states interested in designing and testing new approaches to delivering health care in order to “bolster health care quality and decrease costs.”  CMS expects that states participating in this “State Innovation Models Initiative” will work

Supreme Court Issues Long-Awaited Health Reform Decision: Upholds Entire Law, but Imposes Certain Restrictions on Medicaid Expansion

In the most closely-watched decision of its 2012 term, Chief Justice Roberts delivered the opinion for a majority of a divided Supreme Court today upholding the individual mandate in the Affordable Care Act (ACA).  The vote was 5-to-4.  While the Court also upheld the Medicaid expansion, it narrowly read the federal government’s power to terminate

CMS Proposes New Standards for Medicaid and CHIP Income Eligibility

CMS released a solicitation for public input on June 21, 2012, seeking comments on two potential methodologies for converting current state Medicaid and Children’s Health Insurance Program (CHIP) net income eligibility standards to equivalent modified adjusted gross income (MAGI) standards in accordance with section 2002 of the Patient Protection and Affordable Care Act (PPACA). Starting

CMS Moves Forward with National Average Drug Acquisition Cost (NADAC) Survey and Publication

CMS has announced the implementation of the NADAC survey.  Under this initiative, a CMS contractor will conduct monthly surveys of retail pharmacies nationwide to determine a national weighted average invoice price for retail pharmacy drugs, and then publish and update those “NADACs” on at least a monthly basis on the CMS website.  CMS believes NADACs

Rules Reducing Provider Burden Could Save Them More than $1.1 Billion

The Centers for Medicare & Medicaid Services (CMS) finalized two rules that together are expected to reduce costs for hospitals and other health care providers by over $1.1 billion.  The rules come in response to President Obama’s January 18 Executive Order 13563, which called upon agencies to review existing regulations and to “modify, streamline, expand,

Primary Care Doctors Will Receive a Boost in Medicaid Payments in 2013 and 2014

HHS has released a proposed rule to implement the requirement established by the Patient Protection and Affordable Care Act (PPACA) that Medicaid reimburse primary care providers (i.e., family medicine, general internal medicine, pediatric medicine, and related subspecialties) at not less than Medicare levels during 2013 and 2014.  According to CMS Administrator, Marilyn Tavenner, the pay

Implementing Health Care Reform Community-Based Care Options

The Department of Health and Human Services (HHS) released new rules to implement two community-based care options under Medicaid created by the Patient Protection and Affordable Care Act (PPACA): A final rule implementing the Community First Choice program, a new State plan option for providing home and community-based attendant services and supports to Medicaid beneficiaries

HHS Taking Comments on New Process to Enroll in Certain Health Programs

The Department of Health and Human Services (HHS) has opened a 30-day public comment period on its proposed project to evaluate the implementation of the Express Lane Eligibility (ELE).  Through ELE, state Medicaid or Children’s Health Insurance Programs (CHIP) can enroll individuals in the program based on other agencies’ findings of eligibility, even if those agencies