Monthly Archives: June 2012

Trojan Horse or Meaningful Medicaid Reform?

Posted by William P. Conaboy Jr. on June 22, 2012
Medicaid, Medicare / No Comments

The Centers for Medicare and Medicaid Services (CMS) has outlined its plan to temporarily raise Medicaid rates to Medicare levels for primary care services, and pay states to cover the difference.  On May 11, 2012, CMS issued a proposed rule requiring Medicaid payment for primary care services furnished by eligible physicians at rates “not less than the Medicare rates” for fiscal years 2013 and 2014.[1]  The proposed rule provides for 100% federal matching for any increase in payment above the amounts that would be due under the provisions of a state’s plan as of July 1, 2009.[2]  By increasing Medicaid rates for 2013 and 2014, CMS is implementing certain provisions of the Patient Protection and Affordable Care Act (ACA).  CMS hopes the increased rates will encourage sufficient primary care physician participation in the Medicaid program to accommodate the nearly 16 million new patients that will be eligible to receive Medicaid benefits if the ACA survives the Supreme Court’s review.  The proposed rule does not say, however, what will happen to Medicaid rates – and, more importantly, whether there will be enough physicians to care for the larger Medicaid patient population – after 2014.  Nor does the proposed rule say whether the increased rates for primary care services will be applied regardless of the Supreme Court’s decision. Continue reading…

William P. Conaboy Jr.

Bill Conaboy is an associate in the firm’s Healthcare Law Group. Prior to working with the firm Bill earned a Doctor of Pharmacy degree (Pharm D), and is currently a licensed pharmacist and attorney in both Pennsylvania and New Jersey. Bill focuses on regulatory and litigation matters related to many areas of healthcare law.

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OMG! DC Circuit Rules on PRTFs, CMS, IMDs, and FFP!

Posted by Salvatore G. Rotella Jr. on June 22, 2012
Medicaid / No Comments

The U.S. Court of Appeals for the D.C. Circuit recently held that federal Medicaid funding (FFP) is unavailable for any health care services, other than inpatient psychiatric services, provided to individuals under the age of 21 in a Psychiatric Residential Treatment Facility (PRTF). Virginia Dept. of Medical Assistance Services v. Sebelius, Nos. 11-5161 & 11-5242 (D.C. Cir. May 8, 2012). In reaching that conclusion, and tackling an area of health law with more than its fair share of acronyms, the Court rejected arguments by two state Medicaid programs that FFP should be broadly available for care in a PRTF. This is yet another turn in the long and winding PRTF saga. Continue reading…

Salvatore G. Rotella Jr.

Sal Rotella is a member of the firm and practices in the Health Law Group. Sal handles a variety of health law litigation, regulatory, and compliance matters, and has extensive experience representing behavioral health care providers. He also advises clients on privacy law requirements.

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