Health Care

CCH® Medicare — 5/17/11

Medicare and Medicaid Court action by one state agency against another allowed by Supreme Court A federal court may hear a lawsuit for prospective relief against state agency officials brought by another agency of the same state, the U.S. Supreme Court has held. The Virginia Office for Protection and Advocacy (VOPA) had filed a complaint […]

CCH® Medicare — 5/16/11

Medicare and Medicaid Court upholds denial of loss claims after merger The district court properly upheld the CMS Administrator’s denial of a hospital group’s reimbursement claims arising from the merger of two hospital corporations, according to the U.S. Court of Appeals for the D.C. Circuit. The hospital group argued unsuccessfully that the denial of their […]

CCH® Medicare — 5/13/11

Medicare and Medicaid Hospice wage index Proposed rule issued for fiscal year 2012 CMS has proposed the new hospice wage index for fiscal year (FY) 2012 which would increase Medicare payments to hospices by an estimated 2.3 percent for FY 2012, and CMS expects Medicare hospice payments to increase by $310 million overall in FY […]

CCH® Medicaid — 4/11/11

Medicaid Texas dental plan inadequate under EPSDT The Texas Health and Human Services (HHS) Commission’s motion to modify the Health Outcomes Measures and Dental Assessment Corrective Action Order (CAO) by eliminating the requirements for a dental corrective action plan and a second dental assessment was denied. A class action was filed against the Texas HHS […]

CCH® Medicaid — 4/04/11

Medicaid Medical assistance for Medicaid ineligible immigrants ended The Connecticut Supreme Court upheld a state law ending state-funded medical assistance for immigrants with less than five years’ residence in the United States, reversing an injunction entered by a trial court. In a class action brought by indigent immigrants legally residing in the U.S., the trial […]

CCH® Healthcare Compliance — 3/25/11

Implementation of new provider/supplier enrollment rules In pursuit of its continuing goal of reducing fraud, waste, and abuse in federal health care programs, effective March 25, 2011, CMS will (1) begin determining the level of screening to be conducted during provider and supplier enrollment based on the level of risk posed to the Medicare system, […]

CCH® Healthcare Compliance — 3/22/11

Top management and performance challenges for HHS in 2011 The Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) has identified: (1) health care reform implementation; (2) the integrity of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP); (3) the integrity of HHS public health and human services programs; […]

CCH® Medicaid — 3/17/11

Medicaid Court narrows settlement, limits EPSDT obligations A Tennessee federal court has ruled that several provisions of a 1998 consent decree should be vacated, limiting the enforcement of the state’s obligations under Medicaid’s early and periodic screening, diagnosis and treatment (EPDST) program. The ruling is preliminary because the parties requested time to try to settle […]