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Legal Challenges to Medicaid Rate Reductions Frustrated by Proposed Federal Rules

First few Article Sentences

Providers who participate in Medicaid should familiarize themselves with proposed federal regulations published on May 6, 2011 that, if adopted, would substantially impede their ability to challenge Medicaid rate reductions in court. Interested parties may submit comments to the proposed rules, which must be received by the Centers for Medicare and Medicaid Services (“CMS”) no later than 5 pm EST on July 5, 2011.

The proposed rules interpret a federal Medicaid law that limits how state Medicaid programs can set payment rates. That law, known as “Section 30(A)” of the Medicaid Act, requires state Medicaid Plans to utilize “methods and procedures” that “assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the same extent that such care and service are available to the general population in the geographic area.” These payment-related requirements are known as the “quality” and “access” standards.

Howard, Renee, M.


Bennett Bigelow & Leedom, P.S.

Law, Provider Reimbursement

June 7, 2011

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