Monthly Archives: November 2017

Enforcing the Entitlement to Medicaid: The Ongoing Saga

We have written in the past about enforcing the entitlement to Medicaid through the federal court system.  In light of a recent opinion by the United States Court of Appeals for the 8th Circuit, it seems that this judicial saga continues.

The federal Medicaid statute imposes roughly 80 requirements on a state Medicaid plan.  For example, a state Medicaid plan must make medical assistance available “with reasonable promptness.”  Social Security Act § 1902(a)(8). … More

340B Hospitals File Suit in Wake of Hospital Outpatient Cuts

Back in July, my colleague Tom Barker told you about a CMS proposal to institute a fundamental reimbursement methodological change for 340B drugs used in the hospital outpatient setting.  We have noted before the link between the Medicaid prescription drug rebate program and the 340B program.  As a refresher, in order to have its outpatient drugs covered by Medicaid, the manufacturer must agree to three separate requirements.  First,… More

CMS Issues New Guidelines on 1115 Waivers; Signals New Medicaid Objectives

On November 6, 2017 the Centers for Medicare & Medicaid Services (CMS) issued an information bulletin on changes and improvements to the existing Section 1115 waiver process.[1]  Under Section 1115(a) of the Social Security Act, the Secretary of Health and Human Services is permitted to waive compliance with any of the requirements of section 1902 of the Act (which generally sets forth the requirements for state Medicaid programs in order to receive Federal financial assistance) in order to pilot or test projects which,… More