Perri Nena Smith
Vertical Healthcare Companies Merging Compliance Programs Perri Nena Smith Senior Editor Loyola University Chicago School of Law, JD 2021 In 2020, The Federal Trade Commission (“FTC”) and the Department of Justice (“DOJ”) released guidelines for vertical mergers to give clarity to companies so they can avoid harmful mergers. Healthcare companies are an industry that has been …
he Centers for Medicare & Medicaid Services (“CMS”) refined the Medicaid and Children’s Health Insurance Program (“CHIP”) Managed Care final rules. CMS originally released the final rules in 2016 and another revision in 2018. After several cumulative comments on 2016 and 2018 final rules, CMS attempted to create more flexibility for States with managed care delivery methods. CMS’s third version of the final rules is more of an attempt to clarify and fix technical errors than giving States more flexibility to operate their managed care organizations.
COVID-19 was an unexpected pandemic that hit the United States, causing Centers for Medicare and Medicaid Services (“CMS”) to rush to make accommodations for the states. States administer their Medicaid programs following a state plan and under the regulation of federal rules. With approval, states are allowed to amend their state plan and apply for waivers to improve the effectiveness of their Medicaid program. During COVID-19, the Trump Administration made available for states to apply for 1115 waivers, creating a new section labeling 1115(a), the 1135 waiver, and Appendix K to amend 1915(c) waivers for national emergencies. As of May 2020, CMS reported over 200 approved waivers across multiple states.