Christine Clements

Firm/Organization: Sheppard, Mullin, Richter & Hampton LLP

Latest Articles

CMS Plans Updates to Star Ratings

By Christine Clements & Theresa Thompson on August 29, 2019

On August 19, 2019, the Centers for Medicare and Medicaid Services (“CMS”) announced plans for two updates to its Overall Hospital Quality Star Ratings (“Star Ratings”). The first, in early 2020, to “refresh” the Star Ratings using the current methodology and the second, in 2021, to update the quality measurement methodology of the Star Ratings on CMS’s Hospital Compare website. The Star Ratings rate hospitals on a quality scale of one to five, summarizing a…

Healthcare Law Blog

Is Prescription Drug Pricing The Cure For Partisanship?

By Christine Clements, Bevin Newman, Erica Kraus, Susan Ingargiola & Theresa Thompson on July 25, 2019

In a rare act of bipartisanship, Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Ore., introduced on July 23rd a chairman’s mark, the Prescription Drug Pricing Reduction Act (PDPRA) of 2019 (the “PDPRA” or “Mark”), to lower the price of prescription drugs for Americans. According to the Committee, the Congressional Budget Office (“CBO”) projects that the PDPRA would save taxpayers more than $100 billion in Medicare and Medicaid spending over…

Healthcare Law Blog

SCOTUS Rejects CMS DSH Policy, Calls CMS Guidance Practices Into Question

By Christine Clements & Erica Kraus on June 6, 2019

Earlier this week, the Supreme Court upheld a D.C. Circuit Court decision vacating a policy of the Centers for Medicare and Medicaid Services (“CMS”) that would have “dramatically – and retroactively – reduced payments to hospitals serving low-income patients.” Azar v. Allina Health Services, 587 U.S. __ at 1 (2019). The Supreme Court’s Allina opinion (“Op.” or the “Decision”) is critically important for hospitals that rely on Medicare disproportionate share (“DSH”) payments and has…

Healthcare Law Blog

Arkansas and Kentucky Halt Medicaid Work Requirements

By Christine Clements on April 26, 2019

On April 10, 2019, the Department of Justice filed notices[1] appealing two District Court rulings that struck down Medicaid work requirements in both Kentucky[2] and Arkansas[3] to the U.S. Court of Appeals for the District of Columbia Circuit. The rulings, issued on March 27, 2019, by Judge James E. Boasberg of the Federal District Court for the District of Columbia, held that the U.S. Department of Health and Human Services (“HHS”) acted…

Healthcare Law Blog

OCR Seeks Ideas on HIPAA Rule Changes to Promote Value-Based Care and Coordinated Care

By Christine Clements on December 14, 2018

The Office for Civil Rights (“OCR”) issued a request for information (“RFI”) to assist OCR in identifying provisions of the Health Insurance Portability and Accountability Act (“HIPAA”) privacy and security regulations (the “HIPAA Rules”) that may impede the transformation to value-based health care or that limit or discourage coordinated care among individuals and covered entities without meaningfully contributing to the protection of the privacy or security of individuals’ protected health information (“PHI”).…

Healthcare Law Blog

CMS Issues Proposed Rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses

By Christine Clements on November 28, 2018

The Centers for Medicare and Medicaid Services (“CMS”) released the much-anticipated proposed rule to lower Part D and Medicare Advantage (“MA”) drug prices and beneficiary out-of-pocket expenses on November 26, 2018 (the “Proposed Rule”). According to CMS, the primary purposes of the Proposed Rule are to revise the MA and Part D regulations to support health and drug plans’ negotiation for lower drug prices, and to reduce out-of-pocket costs for plan enrollees. The Proposed Rule…

Healthcare Law Blog

Blog Series: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021

By Christine Clements on October 29, 2018

On October 26, 2018, the Centers for Medicare and Medicaid Services (“CMS”) released for viewing a proposed rule that includes significant changes for Medicare Advantage organizations (“MAOs”), Part D prescription drug plan sponsors (“PDPs”), Medicaid managed care organizations (“MCOs”), and the providers and suppliers that contract with them (the “Proposed Rule”). CMS anticipates that the Proposed Rule will be formally published in the Federal Register on November 1, 2018.…

Healthcare Law Blog

How Broad is the Managed Care Safe Harbor?

By Christine Clements on October 26, 2018

In Advisory Opinion No. 18-11, the Department of Health and Human Services Office of the Inspector General (the “OIG”) addressed a Medicaid managed care organization’s (“MCO”) proposal to pay its contracted providers and clinics (“Network Providers”) to increase the amount of Early and Periodic Screening, Diagnostic, and Treatment (“EPSDT”) services they provide to the MCO’s Medicaid members. Under the State’s MCO program, MCOs are required to provide EPSDT services and face liquidated damages for…

Healthcare Law Blog

CMS’ Medicare Advantage Overpayment Rule: Arbitrary, Capricious, and Vacated

By Christine Clements, Erica Kraus & Michael Paddock on September 7, 2018

In a key case being watched by the industry, Judge Collyer of the United States District Court for the District of Columbia issued an opinion today granting UnitedHealthcare’s Motion for Summary Judgment in UnitedHealthcare Insurance Co. v. Azar, No. 16-157 (D.D.C.), which challenged CMS’ 2014 Overpayment Rule (the “Rule”). Judge Collyer’s decision vacated the Rule in its entirety, finding that, by effectively imposing a 100% accuracy requirement on the data that Medicare Advantage organizations (“MAOs”)…

Christine Clements

CMS Plans Updates to Star Ratings

Is Prescription Drug Pricing The Cure For Partisanship?

SCOTUS Rejects CMS DSH Policy, Calls CMS Guidance Practices Into Question

Arkansas and Kentucky Halt Medicaid Work Requirements

OCR Seeks Ideas on HIPAA Rule Changes to Promote Value-Based Care and Coordinated Care

CMS Issues Proposed Rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses

Blog Series: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021

How Broad is the Managed Care Safe Harbor?

CMS’ Medicare Advantage Overpayment Rule: Arbitrary, Capricious, and Vacated

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