Brown McCarroll Attorneys at Law

On May 7, 2012, CMS published a final rule in the Federal Register (77 Fed. Reg. 26,828) implementing section 2401 of the Affordable Care Act of 2010, which establishes a new state option to provide home and community-based attendant services and supports at a six percentage point increase in federal medical assistance percentage (FMAP). These services and supports are known as Community First Choice (CFC). While this final rule sets forth the requirements for implementation of CFC, they did not finalize the section concerning the CFC setting. The adopted rule is effective July 6, 2012. For further information, contact …

On May 1, 2012, OIG released an opinion stating that a proposed rewards program (the Reward Program) that would allow customers to earn gasoline discounts based on the amount spent on purchases in retail stores and pharmacies -- including cost-sharing amounts paid for items covered by federal healthcare program -- would not be considered remuneration and would not trigger administrative sanctions. OIG explained that there is little risk that the proposed Reward Program would steer federal healthcare beneficiaries to certain stores to purchase federally reimbursable items or services.

On April 20, 2012, HHSC published a proposed rule in the Texas Register (37 Tex. Reg. 2821) regarding the Medicaid RAC program. The proposed rule provides for the review of Medicaid claims submitted to HHSC by a RAC. The RAC will analyze Medicaid paid claims data to determine if services were provided in accordance with state and federal requirements and include review of medical documentation to determine if services were medically necessary. Suspected fraud or abuse may be referred to the HHSC office of inspector general. Providers may appeal RAC audit determinations through the Medicaid appeal process if the claim …

On April 11, 2012, OIG issued a modification to a 2008 OIG opinion, which allowed a charitable foundation to provide financial assistance to financially needy patients diagnosed with cystic fibrosis and pulmonary complications with medical insurance, including those with Medicare and Medicaid, to help them afford the costs of medically necessary prescription drugs used to treat their condition. In 2010, OIG first modified the opinion to provide:

On March 27, 2012, OIG issued an advisory opinion (OIG Advisory Opinion No. 12-02) regarding a company’s proposal to operate a website that would display coupons and advertising for healthcare services and supplies from healthcare providers, suppliers, and other entities (the Proposed Arrangement). The requesting parties of the OIG opinion (the Requesting Parties) set up the Proposed Arrangement so that healthcare providers and suppliers would enter into a contract with the Requesting Parties to pay a flat monthly fee to advertise and post coupons for healthcare services and supplies on the website.