LexisNexis® Legal Newsroom
Williams Mullen: RACs, RACs, RACs…Don’t Forget About the MICs

BY: MARTIN A. DONLAN, JR. & DEREK W. H. KUNG By now, every provider should be aware of the alphabet soup of auditors that could come knocking at the door. There has been more and more activity by RACs and a large push to educate providers about RACs. However, less attention has been paid to...

Foley & Lardner LLP: CMS Issues Final Rule Requiring States to Develop Medicaid Recovery Audit Contractor Programs

By Maria E. Gonzalez Knavel , Anil Shankar , Heidi A. Sorensen , Diane Ung , Lawrence W. Vernaglia and Judith A. Waltz On September 16, 2011, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a final rule (Final Rule) requiring states to implement a Medicaid ...

Foley & Lardner LLP: CMS Announces Comprehensive Primary Care Initiative Soliciting Participation From Health Care Payers

By C. Frederick Geilfuss II , Donald H. Romano , Gary D. Koch , Diane Ung and Lawrence W. Vernaglia The Centers for Medicare and Medicaid Services (CMS) has announced plans to develop a Comprehensive Primary Care (CPC) initiative. In a notice published in the Federal Register on October 3, 2011...

Williams Mullen: Civil Suit Challenging North Carolina Medicaid Appeal Procedures

BY: MARCUS C. HEWITT A civil suit recently filed in North Carolina could affect who decides appeals of agency decisions related to the North Carolina Medicaid program, which could in turn affect the difficulty of appealing agency decisions by the Division of Medical Assistance. Background - Recent...

Attempt to Avoid Probate Earns Medicaid Applicant Penalty Period

Often in an attempt to avoid a relatively small probate fee, individuals can create huge penalty periods and taxable issues for themselves. Take for instance, a woman in New York who, two years before applying for Medicaid, transferred money from her account to an account with a co-owner. Transferring...

Duane Morris LLP: Centers for Medicare and Medicaid Services Releases Proposed Rule on Reporting and Returning of Overpayments

The U.S. Centers for Medicare and Medicaid Services (CMS) released a long-anticipated proposed rule on reporting and returning of overpayments on February 16, 2012. The proposed rule is part of CMS's recent effort to respond to increased Medicare spending through expanded efforts to reduce fraud...

Duane Morris LLP: Supreme Court Addresses Whether Supremacy Clause Provides Private Right of Action to Challenge Medicaid Cuts in Douglas v. Independent Living Center

Representing the latest decision involving Medicaid providers' attempts to judicially combat cuts to Medicaid reimbursement, on February 22, 2012, the U.S. Supreme Court handed down a five-to-four decision in Douglas v. Independent Living Center of Southern California (" Douglas "). At...

State Net Capitol Journal: CT Pulls Plug on Managed Care for Medicaid

The way states used to pay doctors and hospitals for treating Medicaid patients was by directly reimbursing them for the services they rendered. But spurred by criticism that the so-called "fee-for-service" method encouraged health care providers to rack up fees for unnecessary tests and procedures...

Qualifying for Medicaid under MassHealth | 3 Main Reasons for a Medicaid Denial

Questions about Medicaid and MassHealth are usually related to concerns about the ownership and transfer of assets for elderly individuals seeking admission to a long term care facility. Our clients are often uncertain on what types of transfers are ok versus which ones are not. Similarly, they do...

McNees Wallace & Nurick LLC: Planning and Paying for Long-term Care (Part 4 in a Series: Medicaid/Medical Assistance)

B y Scott Alan Mitchell As of January 1, 2012, the average cost of skilled nursing care in Pennsylvania is $8,112.13 per month. Recall that according to national statistics, approximately 50% of nursing care throughout the country is paid by Medicaid - more than double any other source of payment ...

State Net Capitol Journal: States' Medicaid Costs Rising Faster Than Spending

The National Association of Budget Officers (NASBO) and National Governors Association's (NGA) most recent survey of state fiscal health is not particularly encouraging. Although the Spring 2012 update, released last week, indicates state revenues are finally returning to their pre-recession levels...

Discretionary Trust Deemed Available Medicaid Asset

In April 2012, an Ohio Court of Appeals has affirmed [ enhanced version available to lexis.com subscribers ] the state's denial of Medicaid benefits to a deceased nursing home resident's estate , concluding that the resident's irrevocable discretionary trust was an available asset for purposes...

MassHealth Long Term Care Eligibility | Activities of Daily Living

In addition to the complicated financial requirements for becoming eligible for MassHealth long term care benefits, an applicant must also qualify physically . This of course makes perfect sense. If the government provides a service as costly as long term care to individuals for free, then there must...

Wis. Supreme Court Affirms $13.5M Drug Pricing Verdict Against Pharmacia Corp.

MADISON, Wis. - (Mealey's) The Wisconsin Supreme Court on June 22 affirmed a $13.5 million verdict and judgment against Pharmacia Corp. for reporting inflated drug prices and causing the state Medicaid program to overpay, an appeal that stayed the state's cases against 25 other drug company...

Supreme Court Finds Individual Mandate In Health Care Act Constitutional

WASHINGTON, D.C. - (Mealey's) In a sweeping opinion covering four issues addressed over three days of oral argument, the U.S. Supreme Court today found that the Anti-Injunction Act (AIA) does not bar challenges to the Patient Protection and Affordable Care Act (PPACA), that the individual mandate...

NJ Increases Medicaid Penalty Divisor Rate

While the increase of the Medicaid penalty divisor rate is a good thing, the divisor rate is supposed to mimic what a family privately pays for a semi-private room in New Jersey. Now, things might be different in other places, but our clients would find a nursing home with a monthly rate equal to the...

State Net Capitol Journal: GOP Govs Balking at ACA Medicaid Expansion

Several Republican governors said last week they will not expand their Medicaid eligibility standards to conform to the tenets of the Affordable Care Act. Instead they will utilize an out provided within the Supreme Court's ruling on the ACA's legality (see "SNCJ Spotlight: High Court gives...

State Net Capitol Journal: States Cut Medicaid as Feds Prepare for Expansion

Thirteen states are making cuts to their Medicaid programs this year, according to a survey by Kaiser Health News for USA Today. The cuts, most of which took effect July 1st, generally reduce benefits, trim payments to Medicaid providers or tighten eligibility. Alabama, for instance, cut payments to...

State Net Capitol Journal: Malloy Gets Okay to Cut Medicaid

Leaders of key panels in the Connecticut Senate said they will not interfere with Gov. Dannell P. Malloy's (D) effort to cut 13,000 people from the state's Medicaid rolls. Leaders in the Appropriations and Human Services Committees said they will not meet again before August 18, the deadline...

Florida Medicaid Penalty Divisor Increases September 1, 2012

Florida's Medicaid rules are complicated, and always changing. Just a few weeks ago Medicaid increased its so-called monthly penalty divisor. Now, it's been increased again.. Effective Sept. 1, 2012 Florida Medicaid's penalty divisor increases from $6,880 to $7,362. What is the penalty...

Paying for Nursing Home Care with Medicare or Medicaid | How MassHealth Works

After visiting the hospital from a sudden fall, or some other unexpected medical event, an older or elderly patient almost always requires some extended time for recovery. But a hospital bed isn't really the appropriate place for such a long recovery, since hospitals are intended mainly to care for...

Hook Law Center: For Medicaid, Long-Term Care Costs of Elderly are Rising

It should be no surprise that the costs for the long-term care of the elderly are rising. The baby boom generation is now aging, and there are many more of them to take care of. Many of their parents are still requiring services as well. While some people may think only the indigent utilize Medicaid...

Florida's Qualifying Special Needs Trusts

By Mary Alice Jackson * In Florida, a "qualifying special needs trust" can be included for an ill spouse in the healthy spouse's Last Will. All funds transferred into that trust will be excluded from consideration for Medicaid long-term care benefits, thus providing the ill spouse with...

Deirdre Wheatley-Liss: Personal Injury Damages and Medicaid Liens - SCOTUS Decides

You have a horrific accident and are looking at a life of extreme medical care. The accident was caused by another person (drunk truck driver). You get a multi-million dollar award. Does the state that you live in get a share? First, personal injury awards are generally free from income tax. Section...

Ask Liza: Do I Need a Special Needs Trust for a Son on SSDI?

Dear Liza: I have an adult son who is developmentally disabled. He is able to work and receives Social Security Disability Insurance as well as Medicare. Does he need a Special Needs Trust? I love it when someone asks me a question with a clear answer! Here, the answer is probably not. Your son receives...