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Medicaid and Health Equity: CalAIM’s Bold Experiment

Healthcare Law Blog

More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. It envisions enhanced coordination, integration, and information exchange among managed care plans (MCPs); physical, behavioral, community-based, and social service providers; and county agencies.

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Managing Healthcare Compliance in Indiana

MedTrainer

The Indiana Family and Social Services Administration (FSSA) is a state’s Medicaid agency that provides essential support and services, such as healthcare, mental health, and social services, to improve the welfare and quality of life for families and individuals in Indiana. Learn more about MedTrainer today!

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HHS Issues Proposed Rule to Provide Clarity on Rights of Conscience in Healthcare

Healthcare Law Blog

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

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How Serious are OIG Exclusions? Key Insights into the Fraud Risk Spectrum

Provider Trust

Let’s start with the role of the OIG, which is tasked with ensuring that dollars for federal healthcare programs such as Medicare, Medicaid, CHIPS, and TriCare, as well as other healthcare federal grant monies, are judiciously spent and awarded as reimbursements for quality care that is not fraudulent. So what are the risk categories?

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Home Health PPS Final Rule for CY 2024: CMS Steps Back from the Brink

Hall Render

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. 7,872 2018 5,851 77.1% 7,589 2019 5,871 79.3%

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CMS Promotes Competition, Transparency, Health Equity and More in the CY2025 Medicare Advantage and Part D Proposed Rule

Healthcare Law Blog

On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). Please refer to our January 5, 2023 , November 4, 2022 and May 16, 2022 blog posts for more information.

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Medicare Advantage RADV Audit Final Rule Challenged in Court

Healthcare Law Blog

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. The Final Rule therefore violates the APA’s requirement for the Defendants to put forth reasoned agency decision-making.