Coverage of Routine Clinical Trial Costs Under the Medicaid Program

Right before the new year, we told you about some of the Medicaid-related provisions of the COVID relief package that was recently signed into law by President Trump.  One provision of that law that we thought merited a separate article was a new requirement that state Medicaid plans cover the routine patient costs of items and services furnished in connection with the participation by a Medicaid beneficiary in a routine clinical trial. … More

A Deeper Dive into CMS’ Multiple Best Prices Policy

As my colleague Tom wrote about in a recent post, the Centers for Medicare & Medicaid Services (CMS) has finally responded to a growing chorus of stakeholders that government price reporting requirements, particularly Medicaid Best Price (BP), are stifling innovative value-based contracting arrangements (VBAs).  As the proverbial wisdom goes, “nothing changes if nothing changes,” and CMS’ recently finalized proposal to allow manufacturers to report multiple BPs is meant to stimulate innovative changes in contracting for drugs and biologicals.… More

CMS Releases Last Minute Letter of Agreement Establishing New Procedures for Waiver Withdrawals

A quick, timely update for our reader. As reported in our previous posts on the recently approved Tennessee waiver, in likely anticipation of the Biden Administration withdrawing the newly approved, but controversial waiver, on January 4, 2021 CMS Administrator Seema Verma sent a letter (available here) to State Medicaid Directors requesting they sign a Letter of Agreement “as soon as possible”… More

CMS Reneges on Historic “Grand Bargain” with Manufacturers in Tennessee Wavier Approval

If you have not already read it, you can read our main summary of the Tennessee waiver approval HERE.

Now that we have had the chance to read and meditate on the historic Medicaid waiver approved on Friday January 8th, giving Tennessee permission from the Federal government to fundamentally alter Medicaid’s traditional “matching” financing structure for the 1.5 million Tennesseans who rely on the program for healthcare services,… More

CMS Approves Tennessee “Block Grant” Waiver: A Summary and Analysis from your Editors

For our discussion of the new “closed formulary” flexibility approved in Tennessee, you can read our follow-up post here

Introduction

On Friday January 8th, in the final days of the Trump Administration, CMS announced approval of a first-in-the-nation waiver that would permit Tennessee to transition from Medicaid’s longstanding, open-ended financing model to a modified “block grant” model – a financing system under which the Federal government has agreed to commit a discrete amount of dollars to the state,… More

Collecting Overpayments from Medicaid Providers

Today we want to address a topic that many state Medicaid agencies will no doubt be thinking about in the coming months, as the COVID-caused pandemic continues to threaten state finances and Congress has somewhat tied states’ hands in responding to increased Medicaid expenditures by prohibiting coverage disenrollments.  (Although as my colleague Ross Margulies has pointed out here, CMS has recently given states some additional flexibilities in this regard).… More

The 340B Contract Pharmacy Saga Continues

Hello readers of Medicaid and the Law! First and foremost, we here at the blog would like to wish our readers a very happy and healthy new year. We are looking forward to continuing to provide essential insight into some of the most important Medicaid and related health law issues to come in 2021.

Today, we will be providing an update on the “340B Contract Pharmacy Saga.” Back in September,… More

CMS Finalizes Changes to Medicaid Prescription Drug Rebate Program

Earlier this year, my colleague Ross Margulies and I told you about a new proposed rule issued by CMS that makes several changes to the Medicaid prescription drug rebate program, or the MDRP.  Recently, CMS finalized the rule and we thought we’d take this opportunity to tell you about it.  On balance, we think that the rule succeeds in CMS’s stated goals of increasing access to innovative health care therapies to Medicaid beneficiaries as well as clarifying some longstanding questions about the operation of the MDRP.… More

Medicaid Provisions in COVID-19 Relief Package

Here at the Medicaid and the Law Blog, we spent part of our holiday break reading through the most recent COVID-19 relief package that was finally signed into law by President Trump amid a not-insignificant amount of drama.  It was quite an undertaking; the new law is over 5,000 double-spaced pages.  While much of the legislation is related specifically or more generally to COVID-19 and economic recovery,… More

2020 MACStats Released by MACPAC

Earlier today, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its annual MACStats: Medicaid and CHIP Data Book for 2020.  This document contains a wealth of information about the Medicaid and CHIP programs and it is the primary source of information about these two important public health insurance programs.  You can access MACStats here.

This is the first MACStats to derive information from the Transformed Medicaid Statistical Information System (T-MSIS). … More