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CMS Proposes Changes to Medicaid DSH Third-Party Payer Rule

On February 24, 2023, CMS issued a proposed rule updating its Medicaid Disproportionate Share Hospital (DSH) program regulations as a result of legislative changes made by the Consolidated Appropriations Act (CAA) of 2021....more

CMS Changes Trump-era Innovation Models Affecting ACOS

On February 24, 2022, CMS announced major changes to several of its innovation models, including the permanent cancellation of the Geographic Direct Contracting Model—a Trump-era model that tested whether a geographic-based...more

HHS Rescinds Medicaid Work Requirements for Ohio, South Carolina, and Utah, and Reopens Comment Period for Tennessee

On August 10, 2021, CMS notified Ohio, South Carolina, and Utah that it is withdrawing its prior approval of the Medicaid demonstration projects in these states, which had established work requirements as a condition for...more

President Biden Orders Special Enrollment Period for Federal Marketplaces and Review of Policies “Inconsistent” with ACA and...

On January 28, 2021, President Biden signed the “Executive Order on Strengthening Medicaid and the Affordable Care Act” which, among other things, ordered a special enrollment period (SEP) for the federal Health Insurance...more

CMS Issues Guidance to States Regarding Social Determinants of Health Strategies

On January 7, 2021, CMS issued a guidance letter to state health officials describing opportunities under Medicaid and the Children’s Health Insurance Program (CHIP) to address social determinants of health (SDOH). The...more

CMS Expands Medicare Telehealth Services List and Support for State Medicaid Telehealth

On October 14, 2020, CMS added eleven (11) new services to its Medicare telehealth list that are payable during the COVID-19 public health emergency (PHE). This latest expansion of telehealth services is the first to use the...more

OIG Issues Advisory Opinion on Arrangement for Charitable Organization to Buy and Forgive Patient Debt from Providers

On July 24, 2020, OIG issued an Advisory Opinion (AO), AO 20-04, regarding whether an arrangement where a charitable organization purchases or receives donations of unpaid medical debt from health care providers, and then...more

CMS Approves Emergency Medicaid Waivers for Florida, Washington to Address COVID-19; Expects Other States to Apply

On March 13, 2020, President Trump declared the COVID-19 virus a national emergency. Section 1135 of the Social Security Act allows CMS to waive certain regulatory requirements during national emergencies...more

Federal District Court Judge Strikes Down Medicaid Work Requirements in Kentucky, Arkansas

On March 27, 2019, U.S. District Court Judge James Boasberg for the District of Columbia issued two opinions that struck down the Secretary of HHS’s approval of Medicaid work requirement waivers in Kentucky and Arkansas. ...more

New Hampshire Hospital Association v. Azar is Another Win for Hospitals in Medicaid DSH Reimbursement Litigation

On August 25, 2018, the U.S. District Court for the District of New Hampshire in New Hampshire Hospital Association v. Azar gavehospitals another victory in their claims that CMS unlawfully reduces Medicaid Disproportionate...more

GAO Report Finds CMS Needs to Better Target Risks to Improve Oversight of State-Reported Medicaid Expenditures

An August 2018 report by the Government Accountability Office (GAO) titled, “MEDICAID CMS Needs to Better Target Risks to Improve Oversight of Expenditures,” (the GAO Report) identified several weaknesses in CMS’s oversight...more

D.C. District Court Sides with Secretary’s FY 2005 IPPS Final Rule Regarding DSH Calculation of Dual-Eligible Exhausted Days

On June 29, 2018, the U.S. District Court for the District of Columbia decided Stringfellow Memorial Hospital et al. v. Azar by granting summary judgment to the Secretary of HHS in his defense of the FY 2005 Inpatient...more

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