Thomas Barker

Firm/Organization: Foley Hoag LLP

Blogs: Massachusetts Labor & Employment Law, Medicaid and the Law

Latest Articles

CMS Issues Guidance to States on 340B Duplicate Discounts

January 23, 2020

Late last year, we noted that the Massachusetts Medicaid program had proposed regulations to address issues related to the prohibition on duplicate discounts in the 340B program. The Massachusetts solution was relatively straightforward: for high-cost drugs, Massachusetts Medicaid was going to claim the Medicaid rebate on those drugs itself, meaning that qualifying hospitals could not acquire the drugs under the 340B program. Little did we know that CMS was also planning to address the same…

Medicaid and the Law

CMS Is Seeking Guidance on Medicaid Coverage for Children Provided Across State Lines

By Thomas Barker

January 22, 2020

The Medicaid program generally has more generous coverage rules for children than for adults. For example, under the Early and Periodic Screening, Diagnostic and Testing (EPSDT) provisions of the Medicaid statute, if a child’s medical condition is identified via an EPSDT screening, the state’s Medicaid plan must cover treatment for that condition, even if the necessary treatment consists of an optional benefit under the state Medicaid plan. But what happens if the state where…

Medicaid and the Law

MACPAC Releases Updated MACStats

By Thomas Barker

January 2, 2020

Our friends at MACPAC have released the December 2019 edition of MACStats: the Medicaid and CHIP data book. MACStats has data and statistics on virtually any aspect of Medicaid and CHIP that you’d care to learn about. You can find the link to the document here. The data book has five sections: key statistics (including Medicaid and CHIP enrollment which, as we pointed out in a post last month, has been declining for the…

Medicaid and the Law

Massachusetts Medicaid Proposes Changes to Hospital Acquisition of Costly Prescription Drugs

By Thomas Barker

December 10, 2019

Earlier this year, we wrote about a lawsuit involving the 340B drug pricing program. We sometimes write about the 340B program because it is integrally linked to the Medicaid prescription drug rebate program. So today, we wanted to call attention to a proposed regulation issued by the Massachusetts Medicaid program (which is called “MassHealth”) that shows that link clearly. Section 1927 of the Social Security Act requires pharmaceutical manufacturers to provide a rebate to…

Medicaid and the Law

CMS Medicaid Fiscal Accountability Regulation Published

By Thomas Barker

November 15, 2019

Earlier this week, CMS released for publication a proposed rule [1] that would add some degree of transparency and oversight to the somewhat opaque world of Medicaid financing. It’s a topic that’s fascinated us here at the Medicaid and the Law Blog for some time and we’ve written about it on a couple of occasions. Over the years, Congress and CMS (and even before there was a CMS, the Health Care Financing Administration, or…

Medicaid and the Law

Why are Medicaid and CHIP enrollment numbers declining?

By Thomas Barker

November 5, 2019

For much of the past two years, enrollment in the Medicaid and CHIP programs has been declining. In May, 2017, enrollment in both programs was 74.6 million people. As of May of this year, enrollment had declined by 2.5%, to 72.8 million. This decline has applied across the board, in almost every state, for adults and for children. Superficially, this might make sense; after all, the economy is strong and unemployment is at a 50-year…

Medicaid and the Law

As a Public Charge Rule is Finalized by DHS, Concern Over Upcoming DOJ Rule Grows

By Thomas Barker

August 19, 2019

Last Fall, we wrote about a proposed regulation issued by the Department of Homeland Security that involved one of our favorite topics: the intersection of immigration and health care law. My colleague Christian Springer and I have been following this proposed regulation very closely, and last week, it was issued in final form. Because it has generated enormous press attention and because it has significant implications for the Medicaid program, we thought we would use…

Medicaid and the Law

CMS Proposes to Eliminate Its Medicaid Access Monitoring Standards

By Thomas Barker

July 22, 2019

Last week, CMS issued a proposed rule as part of a broader Administration-wide initiative to reduce regulatory and administrative burdens. The proposed rule would absolve states from many of the requirements of a final regulation issued by CMS in 2015 that requires states, before reducing or restructuring payments in their Medicaid programs, to conduct a review (called an access monitoring review plan, or AMRP) of the effect of the proposed rate reductions or restructuring on…

Medicaid and the Law

Medicaid and Non-Emergency Medical Transportation

By Thomas Barker

June 28, 2019

On June 19, the House of Representatives passed the funding bill for the Department of Health and Human Services for fiscal year 2020. CMS is funded in this annual legislation and this funding bill is often a vehicle for Congress to express its support or displeasure for some of CMS’s activities during the year. This year’s bill is no different. Section 239 of the legislation (H.R. 2740) prohibits CMS from publishing a proposed regulation “relating…

Massachusetts Labor & Employment Law

New Employee Benefit Rules Expand Health Reimbursement Arrangement Options for Employers

By Thomas Barker

June 19, 2019

On June 13, 2019, the Internal Revenue Service (IRS), Department of Labor and Department of Health and Human Services (HHS) issued a new regulation that is intended to increase the use of tax-favored health reimbursement arrangements (HRAs) as a means of expanding access to health insurance in the individual insurance market. One likely effect of the new regulation, which will take effect on January 1, 2020, is to make it more likely that small employers…

Thomas Barker

CMS Issues Guidance to States on 340B Duplicate Discounts

CMS Is Seeking Guidance on Medicaid Coverage for Children Provided Across State Lines

MACPAC Releases Updated MACStats

Massachusetts Medicaid Proposes Changes to Hospital Acquisition of Costly Prescription Drugs

CMS Medicaid Fiscal Accountability Regulation Published

Why are Medicaid and CHIP enrollment numbers declining?

As a Public Charge Rule is Finalized by DHS, Concern Over Upcoming DOJ Rule Grows

CMS Proposes to Eliminate Its Medicaid Access Monitoring Standards

Medicaid and Non-Emergency Medical Transportation

New Employee Benefit Rules Expand Health Reimbursement Arrangement Options for Employers

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