Gregory Fantin, Jr.

King & Spalding

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GAO Publishes Findings Regarding Prior Authorization of Behavioral Health Services

Last week, the Government Accountability Office (GAO) published a report determining that there is a nontrivial risk that prior authorization requirements, together with internal coverage criteria, may undermine the Medicare...more

6/9/2025  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , GAO , Health Care Providers , Medicare , Medicare Advantage , Mental Health , Physicians , Prior Authorization , Regulatory Oversight

Texas Sues Federal Government to Protect Medicaid Financing

On December 11, 2024, the Texas Health and Human Services Commission filed a complaint in the United States District Court for the Western District of Texas. The complaint seeks to block the enforcement of a May 9, 2014,...more

12/24/2024  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Enforcement , Medicaid , Social Security Act , State Health Departments , Texas

Federal Judge Vacates Regulation Excluding Section 1115 Days From DSH Formula

On August 15, 2024, the United States District Court for the Northern District of Texas vacated a Medicare regulation excluding from the Medicare DSH payment days attributable to inpatients covered by a section 1115 waiver...more

8/28/2024  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Medicaid , Medicare , Vacated , Waivers

CMS Issues IPPS and LTCH Final Rule for FY 2025

On August 1, 2024, CMS filed a display copy of its final rule for Fiscal Year (FY) 2025 pertaining to the Inpatient Prospective Payment Systems (IPPS) for general acute care hospitals and long-term care hospitals (LTCHs) (the...more

8/7/2024  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Final Rules , Inpatient Prospective Payment System (IPPS) , Long Term Care Facilities , Medicare , Proposed Rules , Provider Reimbursement Review Board , Reimbursements

Biden Administration Streamlines CHIP and Medicaid Enrollment, Expands Protections for Covered Population

Last week, the Biden-Harris administration (the Administration) announced a new rule simplifying the process for enrolling in Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP)....more

4/15/2024  /  Affordable Care Act , Biden Administration , Children's Health Insurance Program (CHIP) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Enrollment , Final Rules , Medicaid , Open Enrollment , Public Health Emergency
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