CMS Proposes New Payment Rule That Will Negatively Affect Some Employee Labor Organizations

This is a brief post about a CMS proposed rule that sort of slipped under the radar last week.  But it has the potential to raise some eyebrows because it is clearly designed to make it harder for labor unions to collect dues from some home health care workers who are paid directly by Medicaid.

Section 1902(a)(32) of the Social Security Act prohibits reassignment of Medicaid funds, and only allows Medicaid funds to be paid directly to individuals performing health care services,… More

Kentucky Medicaid Waiver Blocked by Federal Courts

It has not been a good week for states that want to try innovative Medicaid waivers.  First, CMS shot down Massachusetts’ attempt to re-structure the 25-year old Medicaid prescription drug rebate program to achieve additional savings on the cost of prescription drugs.  And then on Friday, the United States District Court for the District of Columbia effectively blocked Kentucky’s attempt to impose “community engagement” requirements on some Medicaid recipients. … More

CMS Issues Long-Awaited Decisions on MassHealth Prescription Drug Request

It was a busy day for CMS today. After keeping everyone in suspense for months, CMS finally issued its decision on the Massachusetts state Medicaid program waiver request that proposed to limit access to covered outpatient drugs to Medicaid (in Massachusetts, called “MassHealth”) enrollees.  As many observers predicted, CMS did not approve the state’s request.  Notably, however, the CMS response letter provided a pathway for Massachusetts to achieve a substantially similar result. … More

House Committee Advances Bill to Narrow IMD Exclusion for Opioids

We have written in the past about the strange quirk in Medicaid law that prohibits Medicaid from paying for medical services for individuals who are patients in an “institution for mental disease” – a facility that has more than 16 beds and that is “primarily engaged” in providing diagnosis, treatment and care to individuals with mental illness.  This prohibition – commonly known as the “IMD Exclusion” – is a vestige of the original Medicaid program,… More

Trump Administration Draws a Line in the Sand on Medicaid Waivers

If recent history provides us with any guideposts on how the current Administration will review and approve (or not approve) State waiver requests, today’s news may come as a bit of a surprise. In the wake of recent approvals of never-before-seen waivers — including the imposition of new work requirements in Kentucky, Indiana , and Arkansas — today we learned that CMS has said no to lifetime limits on Medicaid benefits in the state of Kansas.… More

An Unlikely Tale of the Evolution of Medicaid DSH

We have posted over the past several months about some interesting Medicaid litigation across the country involving Medicaid disproportionate share (DSH) payments.  In this post, we try to explain a bit more about disproportionate share payments, how the payments work, and how the program has evolved over the past three and a half decades. As we discuss – this evolution has often been circuitous,… More

Home Health and Personal Care Services in Medicaid: Addressing Compliance Risks

One of the major concerns that policymakers deal with constantly in federal health care programs like Medicare and Medicaid is the risk of program fraud and abuse.  And although there are a plethora of statutes designed to address these concerns – the False Claims Act, the Anti-Kickback Statute and the Civil Monetary Penalties statute, to name a few – Congress, CMS and law enforcement are always on the lookout for ways to nip fraudulent activities in the bud. … More

What the Trump Administration’s New Executive Order on Work Requirements Means for Medicaid

In the midst of a busy day on Capitol Hill yesterday, President Trump signed a long-anticipated Executive Order (EO) entitled, “Reducing Poverty in America by Promoting Opportunity and Economic Mobility.” Notably, the EO directs various Federal agencies (including the Department of Health and Human Services) to review existing guidelines on publish assistance programs to ensure they are in line with the President’s outlined “Principles of Economic Mobility.”… More

CMS is Dealt Yet Another Blow in First Circuit Medicaid DSH Case

Last summer we wrote about an interesting court case involving payments to disproportionate share hospitals (DSH) under the Medicaid program.  It’s one of the hottest issues in Medicaid right now; seven courts have invalidated the CMS policy that is at issue.  The most recent decision came last week, in the US Court of Appeals for the First Circuit, involving a challenge brought by New Hampshire hospitals.… More

CMS Finalizes Updates to the Medicaid Drug Rebate Agreement

On March 23, CMS finalized updates to the Medicaid National Drug Rebate Agreement (NDRA) for the first time in 27 years to incorporate legislative and regulatory changes that have occurred since the Agreement was first published.  As my colleague previously wrote, CMS proposed changes to the NDRA in November 2016—most, though not all, of the proposed changes were finalized.

On March 26,… More