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Healthcare Beneficiaries

Conn Kavanaugh

The Importance of Estate Planning for Families

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Everyone should have an estate plan. Your estate plan is the roadmap in a crisis, providing guidance to loved ones on how to proceed and ensuring your wishes and goals are met. For those with young children or children with...more

King & Spalding

Supreme Court Holds Medicaid Participants Lack Standing to Enforce “Any-Qualified-Provider” Clause

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On June 26, 2025, the Supreme Court ruled that Medicaid providers and beneficiaries lack the ability to enforce the Medicaid Act’s “any‑qualified‑provider” clause in federal court. In Medina v. Planned Parenthood, the Court...more

Troutman Pepper Locke

U.S. Supreme Court Holds Medicaid’s Any-Qualified-Provider Provision Does Not Confer Enforceable Rights

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The U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s...more

Dentons

Ep. 59 – Treating Medicare Beneficiaries as a Cash-Based Practice

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Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more

Stotler Hayes Group, LLC

Medicaid Application Process: Top Tips for Applying for Medicaid

Applying for Medicaid benefits, particularly long-term care benefits, can be difficult and confusing. Yet, it is a necessary evil for many who rely on Medicaid to ensure that they can afford the room, board, care, and...more

Rivkin Radler LLP

Don’t Leave Your Final Wishes Open to Interpretation

Rivkin Radler LLP on

The media is filled with stories of deceased celebrities whose final wishes were either unknown or the subject of dispute. An important lesson: You can retain control of your finances after incapacity and remain in control of...more

Offit Kurman

Ethical Wills: The Heart of Your Estate Plan

Offit Kurman on

When most people think of estate planning, Trusts and Last Wills and Testaments usually come to mind. I have spent my career espousing the essential tools for ensuring an efficient transfer of assets from one generation to...more

Mandelbaum Barrett PC

Elder Law and Special Needs Newsletter: December 2024 Issue

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The Great Wealth Transfer: Preparing the Next Generation - The great wealth transfer is underway in America. Through 2045, Baby Boomers will pass down approximately $84 trillion to Gen Z, Millennials, and Gen X. But what...more

HaystackID

AI Healthcare Controversy Highlights Critical eDiscovery Challenges

HaystackID on

A landmark healthcare AI controversy has emerged as a watershed moment for eDiscovery professionals, revealing unprecedented challenges in investigating AI-driven decision-making systems within legal proceedings. The case,...more

Allen Barron, Inc.

Update your Trust and Estate Plan Regularly to Protect Your Interests

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It is important to update your trust and estate plan regularly to protect your interests and meet the changing requirements of your future while integrating changes in law and best practices to provide for every potential...more

Bass, Berry & Sims PLC

CMS Finalizes CY 2025 Medicare Advantage Rule, Confirming Continued Focus on Marketing Practices and Health Equity

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On April 4, the Centers for Medicare & Medicaid Services (CMS) issued the Contract Year (CY) 2025 Medicare Advantage (MA) Final Rule (Final Rule), which will have significant implications for MA plans and other industry...more

Sheppard Mullin Richter & Hampton LLP

District Court Elucidates the Meaning of “to Induce” Under the Federal Health Care Program Anti-Kickback Statute

The United States District Court for the Eastern District of Virginia recently dismissed an appeal by the Pharmaceutical Coalition for Patient Access (“PCPA”) that challenged a negative opinion issued by the U.S. Department...more

Mintz - Health Care Viewpoints

CMS Announces New Model for the Delivery of Integrated Behavioral and Physical Health Care

With the goal of enhancing health care quality and outcomes for individuals with moderate to severe behavioral health conditions and substance use disorders (SUD), the Centers for Medicare & Medicaid Services (CMS) recently...more

Foley Hoag LLP - Medicaid and the Law

CMS Issues Rule Implementing Medicaid Redetermination Policies

We’ve written recently about the process that states are undertaking to begin to wind down the Medicaid enrollment expansion that was necessitated by the enactment of the Families First Coronavirus Response Act in March of...more

Foley & Lardner LLP

Medicare Advantage Agent and Broker Compensation: Commissions, Administrative Payments, and Referral Fees under 42 C.F.R. §...

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A common question in the context of Medicare Advantage (“MA”) distribution and compensation is how agents and brokers may be compensated for commissions and administrative payments and whether, and to what extent, referral...more

Harris Beach Murtha PLLC

Veterans Day: Benefits For Those Planning Their Estates

With Veterans Day upon us, it is a perfect time to not only thank those who served our country, but remind them of the special benefits available to them as they plan their estates. The U.S. Department of Veterans...more

Chambliss, Bahner & Stophel, P.C.

Seniors Often Must Fight for Medicare Home Health Benefits

Medicare is mandated to cover your home health benefits with no limit on the time you are covered. Unfortunately, few Medicare beneficiaries get the level of service they are entitled to, and many find their services cut off...more

King & Spalding

OIG Issues Advisory Opinion Regarding Pharmaceutical Manufacturers’ Program to Provide Free Limited Drugs to Beneficiaries When...

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On August 12, 2015, the Department of Health and Human Services Office of Inspector General (OIG) posted Advisory Opinion No. 15-11, finding that a program to supply a limited amount of free cancer drugs to federal health...more

King & Spalding

OIG Recommends Improvements to Skilled Nursing Facility Billing Policies Regarding Changes in Therapy

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The Department of Health and Human Services Office of Inspector General (OIG) recently issued a report that calls for CMS to accelerate its efforts to implement a new method for paying for changes in skilled nursing facility...more

McDermott Will & Emery

CMS Proposes Value-Based Purchasing Model, Other Updates to the 2016 Home Health Prospective Payment System

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The U.S. Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) published its proposed update to the home health prospective payment system (HHPPS) for calendar year (CY) 2016 in the July...more

Arnall Golden Gregory LLP

CMS Proposes to Establish Separate Payment for End of Life Planning Services

On July 8, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that updates payment rates and related reimbursement and quality policies for physician services furnished under the Medicare...more

Mintz - Health Care Viewpoints

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Arnall Golden Gregory LLP

GAO Recommends Congress Reduce Incentives for Prescribing 340B Drugs

The United States Government Accountability Office (GAO) recently released a report entitled “Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals” (“the...more

Foley & Lardner LLP

Beneficiary Assignment Under the MSSP Final Rule

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This is the fourth post in Health Care Law Today’s series on the final rule. This post addresses how CMS assigns beneficiaries to an ACO participating in the MSSP. In the MSSP ACO Final Rule, CMS finalized new...more

Foley & Lardner LLP

Beneficiary Assignment in the Proposed Revised Medicare Shared Savings Program Regulations

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This post addresses the changes that the rule would make to how CMS assigns beneficiaries to an ACO participating in the MSSP. The Proposed Rule places a renewed emphasis on primary care for beneficiary assignment. Section...more

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