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Final Medicaid Managed Care Rule Updates Requirements Regarding Access, Finance, and Quality

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Medicaid and Children’s Health Insurance Program Managed Care Access, Finance and Quality Final Rule, a final rule that updates several...more

CMS Finalizes Medicaid Access Rule: Significant Changes Ahead for HCBS Industry

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued Ensuring Access to Medicaid Services, a final rule designed to address a range of barriers that Medicaid beneficiaries face in accessing home- and...more

CMS Finalizes Rule Establishing Minimum Staffing Standards for Long-Term Care Facilities

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting,...more

SAMHSA Final Rule Regarding OTPs Expands Access, Increases Flexibility for Patients

On February 1, 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a final rule revising 42 CFR Part 8, which regulates opioid treatment programs (OTPs). The final rule is the first update to...more

California Finalizes SB 184 Pre-Transaction Notice Requirements for “Material Change” Health Care Transactions

On December 18, 2023, the California Office of Administrative Law approved the emergency regulations promulgated by the Office of Health Care Affordability (OHCA) that set forth the procedural framework for (i) the...more

Podcast: Health Equity – Behind the Buzzwords – Diagnosing Health Care [Video]

Under the Biden administration, the Centers for Medicare & Medicaid Services published a health equity framework that drastically changed the playing field for health plans and other risk-bearing entities. In the wake of...more

California Enacts Statute That Furthers Efforts to Move Toward a Unified Health Care Financing System

On October 7, 2023, California Governor Gavin Newsom signed SB 770 into law, providing for the further development of a framework to establish a unified health care financing system in California....more

CMS Announces the Making Care Primary Model, a Multistate Initiative to Strengthen Primary Care

On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), announced a new demonstration model under the authority of Section 1115A of the Social Security Act that...more

Biden Administration Prioritizes Health Equity in Proposed Reforms to Medicare Managed Care

The Centers for Medicare & Medicaid Services (CMS) recently issued the Medicare Advantage (MA) and Part D proposed rule for contract year 2024 (the “Proposed Rule”), which represents the Biden administration’s broadest effort...more

ACO REACH Model: Legal Requirements for ACO Agreements with Providers

The Program The ACO REACH (short for “Accountable Care Organization Realizing Equity, Access, and Community Health”) Model is the new Medicare value-based payment demonstration model for providers launched this year by the...more

U.S. Department of Labor Settles Unprecedented Lawsuit Against United Healthcare for Violations of the Mental Health Parity and...

In the clearest indication yet of the increased enforcement of the Mental Health Parity and Addiction Equity Act (“MHPAEA”) under the Biden-Harris administration, two settlement agreements filed on August 11 provide that...more

New York’s Strict Requirements for Insurers’ Mental Health and Substance Use Disorder Parity Compliance and Oversight Programs May...

The Mental Health Parity and Addiction Equity Act (“MHPAEA”) and related state parity laws are some of the most complex and sweeping regulations ever imposed on the health insurance and managed care industry. Although MHPAEA...more

New Jersey’s Surprise Medical Bill Law: Part 2: Comparison to New York’s and California’s “Surprise Bill” Laws

New Jersey’s Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (“NJ Law”) creates a statutory framework that attempts to protect consumers from medical bills for out-of-network services...more

Expansion of Medicare Advantage Supplemental Benefits: A New World of Opportunities for Providers

Hospitals, health systems, provider groups, and residential and community-based long-term care providers (collectively, “Providers”) should revisit their relationships with Medicare Advantage plans (“MA Plans”) in light of...more

SAMHSA Finalizes Additional Changes to the Confidentiality of Substance Use Disorder Patient Records Regulations

On January 3, 2018, the Substance Abuse and Mental Health Services Administration (“SAMHSA”) published a final rule (“Final Rule”) to further update the Confidentiality of Substance Use Disorder Patient Records regulations...more

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