CMS issues final rule on eligibility, appeals, and enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and Exchanges pursuant to the Affordable Care Act (ACA)

On November 30, 2016, a final rule issued by the Center for Medicare and Medicaid Services (CMS) was published in the Federal Register (81 Fed. Reg. 86382), which, according to the preamble of the regulation, “continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the ACA.” [More]

California health care provider to pay more than $2 million to settle HIPAA violation

Recent media reports have stated that St. Joseph Health in Irvine California has agreed to pay $2.1 million to settle allegations that its 14 hospitals and other health care operations left personally identifiable records of 31,800 people exposed on a newly-installed computer server. As reported, this marks the 12th Health Insurance Portability and Accountability Act (HIPAA) violation settlement this year, a record number. [More]

Texas Supreme Court denies appeal of lower court decision refusing to prevent legislative cuts to Medicaid rates for certain children’s home services

On Friday, September 23, 2016, the Texas Supreme Court refused to hear an appeal of a lower court decision, which held that certain providers and children’s advocacy groups lacked standing to invoke court jurisdiction in an attempt to prevent a state legislative $350 million Medicaid rate reduction for certain services to children with disabilities. [More]

Proposed rule clarifying limit on Medicaid DSH Payments

In the August 15, 2016 Federal Register, the Center for Medicare and Medicaid Services (CMS) published a proposed rule (81 Fed. Reg. 53980) clarifying that Medicaid Disproportionate Share Hospital (DSH) payments under section 1923(g)(1)(A) of the Social Security Act (SSA) should be limited to uncompensated care costs. [More]

Federal Court of Appeals Panel strikes down 2014 CMS rule outlawing stand-alone fixed indemnity insurance policies for ACA purposes

On July 1, 2016, a Three-Judge Panel of the U.S. Court of Appeals for the District of Columbia Circuit overturned a 2014 final rule of the Centers for Medicare and Medicaid Services (CMS) that prevented individuals from having fixed indemnity insurance policies, which did not meet the “minimum essential insurance coverage” requirement of the Affordable Care Act (ACA). [More]