Medicaid, Patient Access

Manufacturer Rebate Models: The Next 340B Program Battleground

Quarles & Brady LLP on 8/5/2025

The 340B Drug Pricing Program (“340B Program”) space continues to be a hive of activity. While 340B stakeholders continue to litigate ongoing manufacturer contract pharmacy restrictions, states legislatures are enacting...more

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

Troutman Pepper Locke on 6/27/2025

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

OIG Approves Proposal that Expands Patient Access to Covered Telehealth Services

Bass, Berry & Sims PLC on 6/25/2025

On June 11, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published Advisory Opinion 25-03, approving a proposal by a management services organization (MSO) and its friendly PC...more

Medicare's Innovation Center Charts New Direction: Part 3 – Drugs, Devices, and Data

Jones Day on 6/13/2025

The Center for Medicare and Medicaid Innovation ("CMMI") is set to reshape value-based care. In the third of a three-part series highlighting this new direction, this summary is focused on CMMI's efforts regarding drugs,...more

Is a Civil Rights Lawsuit by Private Parties a Means to Enforce a Federal Free Choice of Medicaid Provider Provision? A Spending...

Pullman & Comley, LLC on 3/24/2025

CASE AT A GLANCE - In 2018, Planned Parenthood South Atlantic (PPSAT) and one of its patients, Julie Edwards, sued the administrator of South Carolina’s Medicaid program to enforce the “free choice of Medicaid provider”...more

Executive Order on Health Care Access for Gender-Affirming Treatments for Minors

Seyfarth Shaw LLP on 2/12/2025

Following through on a campaign theme focused on transgender issues and access to gender-affirming health care, on Friday, January 28, President Trump signed an Executive Order, titled “Protecting Children from Chemical and...more

Continuity in Coverage: CMS Extends the Unwinding SEP & Issues Final Rule for Medicaid and CHIP Enrollment

Sheppard Mullin Richter & Hampton LLP on 4/3/2024

On March 28, 2024, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced that it is extending the temporary special enrollment period (the Unwinding SEP)...more

The Great Unwinding And Its Effect On Skilled Nursing Facilities

Stotler Hayes Group, LLC on 3/18/2024

Following the termination of the Public Health Emergency (“PHE”) as a result of COVID-19, and the continuous enrollment provisions put in place to ensure that Medicaid beneficiaries were able to receive Medicaid benefits...more

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

Whiteford on 3/1/2024

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more

New Mexico Latest State to Expand Medicaid Behavioral Health Program, Add Mobile Crisis Intervention Program

Mintz - Health Care Viewpoints on 2/21/2024

New Mexico recently became the latest state to receive Centers for Medicare & Medicaid Services (CMS) approval to expand the state’s behavioral health service offerings through mobile crisis intervention teams. Under...more

CMS Issues Final Rule Aimed at Improving Prior Authorization Processes

King & Spalding on 1/26/2024

On January 18, 2024, CMS released a pre-publication version of a final rule (the Final Rule) that will require Medicare Advantage organizations (MA or Part C), Medicaid and the Children’s Health Insurance Program (CHIP)...more

OIG Publishes Strategic Plan for Managed Care Oversight on New Featured Webpage

King & Spalding on 9/12/2023

On August 28, 2023, OIG released a new webpage on managed care oversight, which features the HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid. OIG has designated oversight of managed care as a...more

The Supreme Court’s Talevski Decision: Medicaid Private Enforcement under Section 1983 Lives to See Another Day

Foley Hoag LLP - Medicaid and the Law on 6/13/2023

Today’s post provides an important update on the Supreme Court case Health & Hospital Corporation of Marion County (HHC) v. Talevski. As readers will remember, our blog has been following this case since it made its way to...more

CMS Attempts to Reduce Appointment Times for Medicaid and CHIP Patients - How Will This Impact Your Managed Care Plan?

Nossaman LLP on 6/5/2023

A recent survey found that the average wait time for a new patient to see a physician in 15 of the largest cities in the U.S. was 26 days, up from 24.1 days in 2017. Timely access to health care providers has long been an...more

CMS Releases Proposed Rule: Medicaid Program; Ensuring Access to Medicaid Services

McDermott+ on 5/10/2023

On May 3, 2023 the Centers for Medicare & Medicaid Services (CMS) published the proposed rule Medicaid Program; Ensuring Access to Medicaid Services. The proposed rule seeks to increase transparency in payment rates,...more

The Expiration of the COVID-19 Public Health Emergency: Part II – Impact on the Provision of Medical Services via Telehealth

Bodman on 4/26/2023

As announced by the White House on January 30, 2023, the public health emergency (PHE) is set to end on May 11, 2023. The end of the PHE also brings an end to several flexibilities that were implemented that impact telehealth...more

Medicaid › Patient Access

Manufacturer Rebate Models: The Next 340B Program Battleground

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

OIG Approves Proposal that Expands Patient Access to Covered Telehealth Services

Medicare's Innovation Center Charts New Direction: Part 3 – Drugs, Devices, and Data

Is a Civil Rights Lawsuit by Private Parties a Means to Enforce a Federal Free Choice of Medicaid Provider Provision? A Spending...

Executive Order on Health Care Access for Gender-Affirming Treatments for Minors

Continuity in Coverage: CMS Extends the Unwinding SEP & Issues Final Rule for Medicaid and CHIP Enrollment

The Great Unwinding And Its Effect On Skilled Nursing Facilities

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

New Mexico Latest State to Expand Medicaid Behavioral Health Program, Add Mobile Crisis Intervention Program

CMS Issues Final Rule Aimed at Improving Prior Authorization Processes

OIG Publishes Strategic Plan for Managed Care Oversight on New Featured Webpage

The Supreme Court’s Talevski Decision: Medicaid Private Enforcement under Section 1983 Lives to See Another Day

CMS Attempts to Reduce Appointment Times for Medicaid and CHIP Patients - How Will This Impact Your Managed Care Plan?

CMS Releases Proposed Rule: Medicaid Program; Ensuring Access to Medicaid Services

The Expiration of the COVID-19 Public Health Emergency: Part II – Impact on the Provision of Medical Services via Telehealth

A Complex Regulatory Landscape Emerges for Telemedicine

Hot Topics in Health Care - November 2022

Hot Topics in Health Care – September 2022

Class Action Lawsuit Filed Against New York State for Failure to Provide Legally Required Mental Health Services to...

OIG’s First Advisory Opinion of 2022 Allows for Expansion of Discount Programs

Health Care Providers Should Take Note of Recent Repeals and Extensions of COVID-Related Executive Orders

Ramping up the drug pricing debate: Dueling bills and paying for health care infrastructure

Tele-Tuesday: OIG Clarifies Stance on Telehealth Fraud Scrutiny

Has COVID-19 forced the telehealth genie out of the bottle?

Medicaid › Patient Access

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