Late last year, we noted that the Massachusetts Medicaid program had proposed regulations to address issues related to the prohibition on duplicate discounts in the 340B program. The Massachusetts solution was relatively straightforward: for high-cost drugs, Massachusetts Medicaid was going to claim the Medicaid rebate on those drugs itself, meaning that qualifying hospitals could not acquire the drugs under the 340B program. Little did we know that CMS was also planning to address the same issue,… More
Category Archives: Uncategorized
On November 13, 2018 CMS (as mandated by Congress in the 21st Century cures Act) issued a State Medicaid Director Letter providing states with guidance on both: (1) existing authority for states to provide support for adults with serious mental illness (SMI) and/or children with a serious emotional disturbance (SED); and (2) a new demonstration opportunity to permit states to offer care for certain individuals with serious mental illness residing in Institutions for Mental Disease (IMDs).… More
Starting Off The New Year With Work: How CMS’ “Work and Community Engagement” Policy Change Could Affect Stakeholders
We hope you enjoyed the holidays and New Year and are getting back into the swing of work. Speaking of work: Medicaid. We have previously covered on this blog (here) the Trump Administration’s growing departure from the Obama Administration with respect to the Medicaid program, but now the departure has become increasingly palpable. On January 11, 2018, CMS announced a new policy supporting states seeking to adopt work and community engagement requirements (together hereinafter referred to as “work requirement”) as part of their Medicaid programs through section 1115 waivers. … More
An appeal recently filed in the United States Court of Appeals for the First Circuit could give further clarity regarding the CMS’s ability to discount Medicaid DSH payments for hospitals that received funds from Medicare and private insurers.
DSH Uncompensated Care Costs and the FAQ Policies
The Medicaid Act requires state Medicaid programs to increase payments to hospitals that treat a disproportionate share of Medicaid and uninsured patients. … More