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

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:


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