Medicaid & the Law

Blog February 04, 2020

CMS Releases Block Grant Guidance: Answers to your FAQs

On January 30, 2020, the Centers for Medicare Medicaid Services (CMS) issued its long awaited and highly anticipated State Medicaid Director Letter (SMD Letter) announcing the “Healthy Adult Opportunity” (HAO) initiative that will allow states to carry out demonstrations to implement either an aggregate or per-capita cap financing model for certain Medicaid populations. Weve previously previewed and highlighted some of the key expectations for this long-awaited guidance…

Blog December 10, 2019

Massachusetts Medicaid Proposes Changes to Hospital Acquisition of Costly Prescription Drugs

Earlier this year, we wrote about a lawsuit involving the 340B drug pricing program. We sometimes write about the 340B program because it is integrally linked to the Medicaid prescription drug rebate program. So today, we wanted to call attention to a proposed regulation issued by the Massachusetts Medicaid program (which is called “MassHealth”) that shows that link clearly. Section 1927 of the Social Security Act requires pharmaceutical manufacturers to provide a rebate to state Medicaid…

Blog November 15, 2019

CMS Medicaid Fiscal Accountability Regulation Published

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 Medicaid and the Law Blog for some time and we've written about it on a couple of occasions. Over the years, Congress and CMS (and even before there was a CMS…

Blog March 08, 2019

MACPAC Takes on OIGs Rebate Rule

If our readers have been paying attention to the news, one thing is apparent: drug pricing is trending. As we've written on here before, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has proposed significant revisions to the discount safe harbor regulations that protect existing rebate arrangements under Medicare Part D and Medicaid Managed Care…

Blog August 07, 2018

Fifth Circuit Decision Jeopardizes Medicaid Protections for Community Health Centers

The United States Supreme Court will have the opportunity to hear an important case out of Fifth Circuit Court of Appeals affecting how states pay community health centers for Medicaid beneficiaries enrolled in a managed care plan. Community health centers represent the largest primary health care safety net for the nation's poorest urban and rural communities. The plaintiff in the case, Legacy Community Health Services…

Blog July 17, 2018

CMS Proposes New Payment Rule That Will Negatively Affect Some Employee Labor Organizations

This is a brief post about a CMS proposed rule that sort of slipped under the radar last week. But it has the potential to raise some eyebrows because it is clearly designed to make it harder for labor unions to collect dues from some home health care workers who are paid directly by Medicaid. Section 1902(a)(32) of the Social Security Act prohibits reassignment of Medicaid funds, and only allows Medicaid funds to be paid directly to individuals performing health care services…

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Blog Editors

Thomas Barker

Partner

Washington, DC

+1.202.261.7310

tbarker@foleyhoag.com

About Our Blog

Foley Hoag has a unique team of healthcare lawyers and specialists with decades of experience in statutory and regulatory analysis, compliance, government investigations, litigation and corporate transactions. Most of our lawyers and healthcare policy specialists have had a direct hand in shaping virtually every healthcare law and regulation enacted over the past four decades, including:

The Patient Protection and Affordable Care Act of 2010
The Medicare Modernization Act of 2003
The Food and Drug Administration Modernization Act of 1997
The Balanced Budget Act of 1997
The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Budget reconciliation laws of the 1980s

Medicaid is also, by far, the largest health insurance payer in the United States and has even surpassed Medicare in terms of the number of enrollees. Medicaid is a crucial component in America’s health care system.

Our focus includes:

Medicaid coverage and reimbursement issues for innovative pharmaceutical products
Legal, regulatory and strategic advice for Medicaid mental health providers and payers
Medicaid waivers
State coverage of the Medicaid expansion population
State-specific Medicaid issues
Medicaid financing
Medicaid and long-term care