Medicaid, Proposed Rules, Health Insurance

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

Marketplace Integrity And Affordability Rule Proposed

McGuireWoods Consulting on 3/18/2025

On March 10, 2025, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that in many respects reverts to pre-Biden administration rules and definitions for health care marketplaces across the country. The...more

PBM Policy and Legislative Update — Winter 2025

Mintz - Health Care Viewpoints on 2/12/2025

The PBM regulatory landscape is rapidly evolving at both federal and state levels, making it critical for our clients involved in the PBM space to stay apprised of developments in the industry as they happen. Our team...more

[Podcast] Health Law Diagnosed – The 2024 Election and Health Care Policy

Mintz on 1/22/2025

In the latest episode of Health Law Diagnosed, host Bridgette Keller dives into potential health care policy changes on the horizon following the November 2024 election. She is joined by Alex Hecht, ML Strategies Executive...more

CMS Releases New Proposed Rule for Medicare Advantage and Part D

DLA Piper on 12/12/2024

On December 10, 2024, the Centers for Medicare and Medicaid Services (CMS) released a Proposed Rule for revisions to the regulations governing the Medicare Advantage (MA) program, Medicare Prescription Benefit (Part D),...more

CMS Proposed Rule Decreases Physician Payments, Expands Telehealth, and Much More

Fox Rothschild LLP on 9/24/2024

The comment period for the CMS CY 2025 Physician Fee Schedule (PFS) Proposed Rule recently closed on Monday, September 9th. Based on previous years, the Final Rule can be expected as soon as early November, taking effect...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 Issues Proposed Rule Regarding the Medicaid Drug Rebate Program

King & Spalding on 6/2/2023

On May 26, 2023, CMS published a proposed rule that would implement new policies under the Medicaid Drug Rebate Program (MDRP) to: (1) address situations in which drug manufacturers incorrectly report or misclassify their...more

CMS Proposes New Rule that Would Require 80% of Payment to Go Toward Home Care Worker Compensation

Robinson+Cole Health Law Diagnosis on 5/8/2023

On April 27, 2023, the Centers for Medicare & Medicaid Services (CMS) released a Notice of Proposed Rulemaking entitled Ensuring Access to Medicaid Services (Proposed Rule) which would, among other things, establish...more

McDermottPlus Check-Up: April 28, 2023

McDermott+ on 5/2/2023

Congress was in session, and it was a busy healthcare week at the committee level, with six hearings focused specifically on health issues. On the House floor, Republicans passed the Limit, Save, Grow Act—a bill that raises...more

CMS Proposed Rule Would Leverage Technology and Interoperability to Improve Prior Authorization

Groom Law Group, Chartered on 12/22/2022

On Tuesday, December 13, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“New Proposed Rule”) to improve the prior authorization process and advance interoperability for Medicare Advantage...more

CMS Releases Long-Awaited Proposed Rule to Ease Medicaid Enrollment Burdens

Foley Hoag LLP - Medicaid and the Law on 9/15/2022

On September 7, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule in the Federal Register to reduce red tape and make it easier for individuals to enroll and retain eligibility in Medicaid, the...more

Digital Health Implications of Recent HHS Anti-Discrimination Proposed Rule

Jackson Walker on 8/8/2022

On July 25, 2022, the Department of Health and Human Services issued a new proposed rule (subsequently published in the Federal Register on August 4) on Section 1557 of the Affordable Care Act (ACA), which prohibits...more

HHS Proposes Rule Strengthening Section 1557 Protections Against Nondiscrimination in Health Activities

BakerHostetler on 8/8/2022

On Aug. 4, the Department of Health and Human Services (HHS) published its proposed rule, Nondiscrimination in Health Care and Activities (Proposed Rule), to revise its regulations pertaining to Section 1557 of the...more

Comments on CMS Proposed Rule on Medicaid Fiscal Accountability Due Feb. 1, 2020

Holland & Knight LLP on 1/14/2020

The Centers for Medicare & Medicaid Services (CMS) on Nov. 18, 2019, published a proposed Medicaid Fiscal Accountability rule that would amend existing regulations related to 1) base and supplemental payments, 2)...more

CMS Medicaid Fiscal Accountability Regulation Published

Foley Hoag LLP - Medicaid and the Law on 11/18/2019

Earlier this week, CMS released for publication a proposed rule that would add some degree of transparency and oversight to the somewhat opaque world of Medicaid financing. It’s a topic that’s fascinated us here at the...more

CMS Proposes New Home Health Agency Rule Including Potential Changes to Reimbursement, Coverage, Quality, and More: CMS Accepting...

Sheppard Mullin Richter & Hampton LLP on 7/17/2019

On July 11, 2019, the Centers for Medicare and Medicaid Services (“CMS”) announced a proposed rule for home health agency Medicare reimbursement that would increase payments by an aggregate 1.3% for 2020, amounting to $250...more

Expansion of Medicaid Eligibility for Undocumented Young Adults

Brownstein Hyatt Farber Schreck on 3/1/2019

In recent weeks, the states of California and Washington, and New York City have proposed expanding Medicaid eligibility for undocumented young adults. Given Medicaid’s combination of state and federal funding, House and...more

HHS Proposes Rule to Eliminate Safe Harbor for PBM Drug Rebates

Sheppard Mullin Richter & Hampton LLP on 2/12/2019

On February 6, 2019, the Office of the Inspector General of the U.S. Department of Health and Human Services (the “OIG”) published in the Federal Register a proposed rule (the “Proposed Rule”) that, if made final in its...more

HHS OIG Proposes Anti-Kickback Safe Harbor Amendments to Regulate and Restrict the Provision of Manufacturer Remuneration to Plan...

Epstein Becker & Green on 2/6/2019

On January 31, 2019, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued a proposed rule (“Proposed Rule”) that would restrict safe harbor protection under the federal Anti-Kickback...more

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