Senate Finance Committee Issues Report on Medicaid Supplemental Payments

The majority members of the Senate Finance Committee released a report last month that delves into the mysterious world of Medicaid supplemental payments.  We thought we’d go through it here, especially in light of some of the litigation going on across the country involving Medicaid disproportionate share (DSH) payments, a form of Medicaid supplemental payments.

The Finance Committee report found that total Medicaid supplemental payments in fiscal year 2016 totaled nearly $50 billion,… More

Recent HHS-OIG Reports Suggest Future Medicaid Reforms

The Department of Health and Human Service’s Office of Inspector General (OIG) has issued a couple of reports lately on Medicaid coverage of prescription drugs and we thought we’d highlight them here.

The first report suggests that the Medicaid program could save hundreds of millions of dollars a year by re-determining the calculation of average manufacturer price (AMP) for some authorized generic products. … More

Massachusetts House Pushes Medicaid Supplemental Rebate Law in Budget

On April 11, 2019, the Massachusetts House Committee on Ways and Means released its FY 2020 budget (H.3800).  The legislation includes provisions authorizing MassHealth (the Massachusetts Medicaid program) to negotiate supplemental rebates directly with drug manufacturers, and provides for further proceedings before the Health Policy Commission for manufacturers refusing to negotiate supplemental rebates at levels satisfactory to the Commonwealth. These provisions represent amendments to a MassHealth drug pricing proposal included in Governor Baker’s FY 2020 filing in January.… More

Court Strikes Down Work Requirements in Arkansas and Kentucky

There’s a saying that one should work hard in the present to reap the rewards later in life.  But should one need to work to qualify for Medicaid?

In a week of legal machinations and legal setbacks on the health care front for the Trump Administration, Judge James E. Boasberg’s opinion in Gresham v. Azar suggests that the answer is no,… More

CMS Updates “Settings that Isolate” Guidance for HCBS Waivers, Providing Relief to Farmstead and Lifesharing Communities

On March 22, 2019, CMS published a long-awaited letter to State Medicaid Directors and a new guidance document regarding the Home and Community-Based Services (HCBS) waiver program.  The letter  revises previous guidance that CMS had provided to states on “Settings that have the effect of isolating individuals receiving HCBS from the broader community” for purposes of receiving Federal funding for services provided under a HCBS waiver. … More

Attorneys Ross Margulies and Tom Barker to Speak at AHLA’s Institute on Medicare and Medicaid Payment Issues

Foley Hoag attorneys and Medicaid and the Law bloggers Ross Margulies and Tom Barker are presenting at the American Health Lawyers’ Association Annual Institute on Medicare and Medicaid Payment Issues in Baltimore this week.

Ross’s presentation will address Medicare and Medicaid payment issues for innovative therapies.  Tom’s will provide an update on Medicaid § 1115 waivers.… More

MACPAC Takes on OIG’s Rebate Rule

If our readers have been paying attention to the news, one thing is apparent: drug pricing is trending.  As we’ve written on here before, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has proposed significant revisions to the discount safe harbor regulations that protect existing rebate arrangements under Medicare Part D and Medicaid Managed Care. … More

Medicaid Long-Term Care: A Background and look at the Eligibility Rules

One of the most common misperceptions of the American health care system is that if an elderly individual – maybe a parent or a grandparent – has to enter a nursing home, their stay will be fully covered by the Medicare program.  But that is not accurate.  Medicare does not cover long-term care.  It will pay for up to 100 days in a skilled nursing facility per spell of illness,… More

HHS Prescription Drug Rebate Rule Has Medicaid Implications

On January 31, 2019 the HHS Office of Inspector General (OIIG) issued a proposed rule that will be published in the Federal Register on February 6.  The proposed rule has the potential to fundamentally re-structure the prescription drug marketplace in the United States by dramatically altering the economics of pharmaceutical pricing.  Although much of the attention surrounding the rule has been focused on its effect on the Medicare Part D prescription drug program,… More

Massachusetts Governor Seeks New Tools to Negotiate Rebates

It was just earlier this week that we were writing about a flurry of solicitations released by the the Massachusetts Executive Office of Health and Human Services (EOHHS) seeking bids from manufacturers of select, generally high-priced outpatient drugs for supplemental rebates in MassHealth’s fee-for-service and managed care programs. At that time, we noted that this exercise was likely foreshadowing the release of Governor Baker’s budget proposal.… More