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

Viewing CMS’ Proposed Rule On the Equal Access Requirement Through A Legal Lens

Our readers may remember our discussion of the ongoing saga surrounding enforcement of the entitlement to Medicaid.  We have covered it several times before (here and here) on this blog.  Aside from discussing the topic because it allows us to flex our legal muscle with italicized case names, we also believe it’s critical for our readers to understand how Medicaid entitlement has evolved over time. … More

Breaking Down Medicaid Financing

In the past several months, we have highlighted some fascinating Medicaid litigation against CMS in several US District Courts across the country.  This litigation deals with the Medicaid disproportionate share hospital (DSH) requirements of section 1923 of the Social Security Act.  But what we haven’t focused on – until now – is how the DSH program fits into the overall Medicaid financing system.  It’s a topic of enormous complexity with a rich 35-or more year history. … More

Blogging Live from AHLA: Medicaid Litigation Update – Challenges to Waivers

Reporting live from the American Health Lawyer’s Association 2018 Institute on Medicare and Medicaid Payment Issues in Baltimore, MD, we are back again. This time, we are reporting on a deeply comprehensive program on recent trends in Medicaid litigation led by Alan Dorn, Chief Counsel of HHS Region V in Chicago, and Felicia Y Sze, a partner of Rotenberg & Sze LLP in San Francisco.… More

Blogging Live from AHLA: Enforcing the Medicaid Entitlement

My colleague Tom Barker and (my former boss) Professor Sara Rosenbaum just finished a series of back-to-back sessions on enforcing the Medicaid entitlement – the sessions were entertaining and engaging for all involved. We have written about this topic previously – notably here and here. Tom and Sara’s excellent slide deck can be viewed here:

  More

Blogging Live from AHLA: Calder Lynch on the Medicaid Program

During the opening session of AHLA yesterday, we had the opportunity to hear remarks for Calder Lynch, current Counselor to CMS Administrator Seema Verma and potential replacement pick for outgoing CMCS Director. Lynch reiterated the three pronged approach the current administration is taking to Medicaid (as previously outlined by administrator Verma):

  1. Accountability
  2. Flexibility
  3. Program Integrity

According to Lynch,… More

Blogging Live from AHLA: A Review of Recent Trends in Medicaid Waivers

Good morning from snowy Baltimore! Myself, along with my colleagues Tom Barker, Sean Ahern, and Erik Schulwolf are excited to be here here at AHLA’s Institute on Medicare and Medicaid Payment Issuers. Over the next few days we plan on blogging about our insight, key sessions, and other fun tidbits and developments as we take in all of the great information at this annual gathering of the health bar.… More

CMS Approves More Medicaid Work Requirements and Even More States Submit Request for the Same

We’re certain that no one has forgotten about the January CMS policy announced by the current administration that supports states seeking to adopt work and community engagement requirements as part of their Medicaid programs through section 1115 waivers. We certainly have not. We previously covered this topic in-depth following CMS’ policy announcement and the approval of Kentucky’s 1115 waiver containing a work requirement.… More

Trump Administration Outlines Priorities For FY 2019

The past couple of weeks have involved a flurry of healthcare-related developments, including on the Medicaid drug pricing front.  On February 9, 2018, President Trump signed into law the Bipartisan Budget Act of 2018, which revises the rebate formula for line extensions applicable to certain drugs in the Medicaid program.  Then later that same day, the Council of Economic Advisors issued a report titled “Reforming Biopharmaceutical Pricing at Home and Abroad,” which among other things,… More

Come see us at AHLA!

On March 21 and 22, two of this blog’s authors will be presenting on two Medicaid topics at the American Health Lawyer’s Association (AHLA) annual Medicare and Medicaid conference in Baltimore, Maryland.

One of the hottest topics in Medicaid right now is the Trump Administration’s policy on granting Medicaid waivers to states, a topic we have posted about here, here and here. … More