Health Law Advisories Archive

Hooper, Lundy & Bookman, PC,  has joined forces with ECG Management Consultants, Inc. to produce this article outlining the key elements of MACRA and its impact on health care providers that bill Medicare for physician services.

This is the first in a multipart series exploring the impact of MACRA as it unfolds and highlighting ways for hospitals and other providers to stay ahead of the curve.

Every health care provider that treats managed Medicaid patients would be impacted financially and operationally under sweeping changes to Medicaid managed care proposed by the Centers for Medicare & Medicaid Services (CMS) on May 26, 2015. This is the first major update to Medicaid managed care in 42 C.F.R. Part 438 in over a decade. The aims to align Medicaid managed care with Medicare Advantage and private market policies, bolster state delivery reforms, impose new quality ratings, set up best practices. The proposed rule directly impacts Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), Prepaid Ambulatory Health Plans (PAHPs), and Primary Care Case Managers (PCCMs). We have highlighted important issues in the proposed rules affecting healthcare providers here and posted a redline of the proposed changes to the current 42 C.F.R. Part 438 here.