U.S. District Court in Connecticut certifies nationwide class of Medicare beneficiaries in challenge to “observation status”

On July 31, 2017, the U.S. District Court for the District of Connecticut certified a nationwide class of Medicare beneficiaries who desire to challenge their placement on “observation status” during their hospital stays. Alexander v. Price, No. 3:11-cv-1703 (D. Conn. July 31,2017).

The plaintiffs in this long-running action argue that the decision to categorize Medicare beneficiaries as outpatients on observation status rather than inpatients should be subject to administrative review. Currently, Medicare does not allow beneficiaries to appeal this determination. [More]

Massachusetts Supreme Judicial Court holds that the retention of the right to live in a home transferred to an irrevocable trust does not render the home an “asset” for Medicaid purposes

On May 31, 2017, the Supreme Judicial Court of Massachusetts reversed and remanded two cases involving determinations of eligibility for long-term care assistance under the Massachusetts Medicaid program (MassHealth). Nadeau v. Director of the Office of Medicaid and Daley v. Secretary of the Executive Office of Health and Human Services, SJC 12200 and 12205, May 31, 2017. [More]

U.S. Supreme Court rejects West Virginia’s challenge to Obama administration’s decision not to enforce certain provisions of the Affordable Care Act (ACA)

On Monday, April 17, 2017, the U.S. Supreme Court declined to take up West Virginia’s challenge to the decision by the Obama administration not to enforce certain mandates of the ACA following the cancellation of millions of plans by insurance companies in 2013. (West Virginia, Ex Rel. Morrisey v. Dept. of H & HS, 16-721, 4/17/17). [More]

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]