medicaid – Page 2 – Duane Morris Health Law

January 17, 2012September 10, 2014 by Duane Morris

CMS Finalizes Rules Regarding Eligibility for Medicare Prescription Drug Subsidy

On January 17, 2012 the Centers for Medicare & Medicaid Services (“CMS”) adopted as a final rule changing Medicare’s Extra Help Program. The Extra Help Program is a prescription drug coverage low-income subsidy created through the Affordable Care Act (“ACA”). Effective January 18, 2012, the final rule incorporates the ACA’s changes to the Extra Help Program by extending eligibility for one year after the death of a beneficiary’s spouse that would otherwise decrease or eliminate the subsidy. The final rule also implements changes to the Medicare Improvements for Patients and Provider Act of 2008 by excluding from a resource (for purposes of Extra Help eligibility) the value of life insurance policies or income for food, shelter, and certain household bills.

Read the full notice from the federal register here.

December 19, 2011August 19, 2014 by Patricia S. Hofstra

Proposed Physician Payment Disclosure Rule Published

The Centers for Medicare and Medicaid Services (“CMS”) released its proposed rule regarding the required reporting of device, biologics and pharmaceutical manufacturer payments to physicians on December 14, 2011. The proposed rule includes templates for physicians and manufacturers to use when logging payments and gifts.

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November 29, 2011September 10, 2014 by Duane Morris

CMS Issues Final Rule on ACA’s New Medical Loss Ratio

The Centers for Medicaid & Medicare Services (“CMS”) recently released a final rule establishing the new medical loss ratio requirements under the Affordable Care Act (“ACA”). Under the ACA, individual and small group market insurers are required to spend at least 80 percent of premium dollars on medical care and quality improvement, and large group market insurers must spend at least 85 percent of premium dollars on the same services. The final rule describes the technical process for calculating medical loss ratio and also provides details on insurers’ annual medical loss ratio reporting requirements, as well as the ACA’s requirement that insurers grant rebates to consumers in the event the insurer fails to meet the required medical loss ratio.

Read the full text of the rule here, or HHS’ fact sheet on the ACA’s changes to medical loss ratios here.

June 2, 2011August 18, 2014 by Neville M. Bilimoria

Expansion of CMS Never Events: They’re Not Just For Medicare Or Just For Hospitals Anymore

In 2005 when “Never Events” were proposed for hospitals through the Deficit Reduction Act, no one knew what the overall effect would be on hospitals or patient care. CMS later developed these and implemented these Never Events under the authority of the DRA to prevent Medicare payment to hospitals for certain “never events” or hospital acquired conditions (HACs) which were conditions that were high volume, involved higher payment, and which could be easily preventable. Now, hospitals and other health care providers have to worry about Never Events in the Medicaid space.

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April 1, 2011September 10, 2014 by Duane Morris

FTC and DOJ Propose Enforcement Policy for Healthcare Antitrust Laws

The Federal Trade Commission and the U.S. Department of Justice have jointly issued a proposed enforcement policy for the application of the antitrust laws to healthcare collaborations among otherwise independent providers and provider groups that seek to participate as accountable care organizations (ACOs) under the Medicare Shared Savings Program. The agencies seek public comments until May 31, 2011, on the proposed enforcement policy and the new antitrust “safety zone” it would create.

For more information and the proposed antitrust policy, please visit the FTC and DOJ’s Proposed Statement.

March 31, 2011September 10, 2014 by Duane Morris

CMS Releases Long-Awaited Proposed Rule on Accountable Care Organizations

On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) unveiled the long-awaited federal rule on accountable care organizations. This proposed rule would implement section 3022 of the Affordable Care Act, which allows service providers and suppliers to continue receiving traditional Medicare fee-for-service payments under Parts A and B, and to be eligible for additional payments based on meeting specified quality and savings requirements.

To view the proposed rule, please visit the Office of the Federal Register website.

March 30, 2011September 10, 2014 by Duane Morris

A Summary of Medicare Shared Savings Program and ACO Proposed Regulations

On March 30, 2011, the Centers for Medicare and Medicaid issued the long-awaited, proposed regulations for the Medicare Shared Savings Program, including details of the requirements for qualifying as an accountable care organization (ACO), such as:

Eligible legal entities
Criteria for shared governance
Assignment of beneficiaries to ACOs
Different types of risk contracts
Benchmarks and calculations of savings
Shared savings, antitrust issues and policies, Medicare anti-kickback, and other regulatory requirements as applied to ACOs

The full text of the summary is available as a Duane Morris Alert.

March 18, 2011September 10, 2014 by Duane Morris

Civil Money Penalties for Nursing Homes

On March 18, 2011, the U.S. Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) issued this regulation, implementing section 6111 of the Affordable Care Act. Section 6111 gives CMS authority to impose and collect civil monetary penalties (CMPs) against nursing homes. The penalties are reserved for nursing homes that fail to comply with federal participation requirements outlined in section 6111. Although penalties for noncompliance existed before the Affordable Care Act was promulgated, this regulation revises and expands CMS’s authority to impose and collect CMPs. The final rule is effective January 1, 2012.

For additional information about this new regulation, please visit the Office of the Federal Register website.

February 22, 2011September 10, 2014 by Duane Morris

$45 Million More in Federal Funding to Assist Medicaid Beneficiaries

On February 22, 2011, the U.S. Department of Health and Human Services (HHS) announced that it would provide $45 million in grant funding to 13 states for the startup and operation of Money Follows the Person (MFP) demonstration projects. States operate MFP programs to provide financial support and assist Medicaid beneficiaries with moving from institutions (i.e., hospitals and nursing facilities) and transitioning back into their communities to live in their own homes or other facilities. HHS anticipates that this federal funding will help 13,000 more Medicaid beneficiaries, and it will continue to provide grant funding through 2016 by committing at least $621 million to the state projects.

To read more about this announcement and see the list of 13 states scheduled to receive grant funding, please go to http://www.hhs.gov/news/press/2011pres/02/20110222b.html.

February 18, 2011September 10, 2014 by Duane Morris

Medicare and Medicaid Programs; Requirements for Long-Term Care Facilities; Notice of Facility Closure

Issued by the U.S. Department of Health and Human Services (HHS)on February 18, 2011, this regulation implements section 6113 of the Patient Protection and Affordable Care Act (PPACA). The interim final rule amends existing legislation by introducing new notice requirements associated with long-term care (LTC) facility and skilled nursing facility (SNF) closures. Its purpose is twofold: to protect resident health and safety, and to facilitate a “smooth transition” in the event of a facility’s closure.

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