On January 8, Massachusetts Governor Maura Healy signed into law “An Act Relative To Pharmaceutical Access, Costs And Transparency.” The Act will have a profound impact on all parties involved in setting and applying drug...more
2/28/2025
/ Cost-Sharing ,
Drug Pricing ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
Medicaid ,
Pharmaceutical Industry ,
Pharmacies ,
Pharmacy Benefit Manager (PBM) ,
Popular ,
Regulatory Requirements ,
Reporting Requirements ,
State and Local Government
With 2025 underway, the AFS Health Care team highlights some of the most pressing legal issues facing the health care industry this year....more
On November 20, 2024, the US Department of Health and Human Services, Office of Inspector General (OIG) issued its Industry Segment-Specific Compliance Program Guidance for Nursing Facilities (Nursing Facility ICPG)....more
1/9/2025
/ Anti-Kickback Statute ,
Assisted Living Facilities (ALFs) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Enforcement ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Risk Management ,
Skilled Nursing Facility
How Massachusetts senior living providers need to be thinking about the recently enacted Long Term Care Reform Law and a recent Centers for Medicare & Medicaid Services audit of nursing homes....more
11/4/2024
/ Affordable Housing ,
Assisted Living Facilities (ALFs) ,
Audits ,
Enforcement ,
Legislative Agendas ,
Long-Term Care ,
Medicaid ,
Medicare ,
Operational Requirements ,
Regulatory Agenda ,
Training
Throughout 2021 and 2022, states have been seeking to include or have successfully included medical respite to Medicaid 1115 waivers. These experimental Medicaid-reimbursed programs are reviewed and approved by the Secretary...more
Over 2500 hospitals across the country historically have relied upon Disproportionate Share Hospital (DSH) Medicaid payments for financial stability. These DSH payments, made in large measure to hospitals with high Medicaid...more
3/31/2023
/ Affordable Care Act ,
American Hospital Association ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
DSH ,
Financial Distress ,
Funding ,
Hospice ,
Hospitals ,
MACPAC ,
Medicaid ,
Proposed Rules ,
Provider Payments
On February 15, 2023, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule which would require greater disclosures of the ownership and management of Medicare and Medicaid nursing homes. Specifically,...more
The Biden Administration has embraced an aggressive and multi-part agenda designed to improve the safety and quality of care nationally in skilled nursing facilities (SNFs). The Biden Administration’s nursing home agenda...more
12/16/2022
/ Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Compliance ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Medicaid ,
Medicare ,
OIG ,
Quality of Care Standards ,
Skilled Nursing Facility
Across the country, health care providers have struggled during the COVID-19 pandemic in the face of declining revenue and increased expenses.
This financial stress has adversely affected almost all entities within the...more
In what is widely considered to signal intensified focus by the Federal government on Medicaid supplemental payments and related State Medicaid financing mechanisms, the Centers for Medicare & Medicaid Services (CMS) on...more
11/26/2019
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Health Care Providers ,
Mandatory Reporting Laws ,
Medicaid ,
Proposed Rules ,
Regulatory Oversight ,
State Medicaid Programs ,
State Regulators ,
Supplemental Payments