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Today we want to address a topic that many state Medicaid agencies will no doubt be thinking about in the coming months, as the COVID-caused pandemic continues to threaten state finances and Congress has somewhat tied states’ hands in responding to increased Medicaid expenditures by prohibiting coverage disenrollments. (Although as my colleague Ross Margulies has pointed out here, CMS has recently given states some additional flexibilities in this regard).
Nevertheless, we expect that states are going to be more aggressive in dealing with providers of services, perhaps by cutting rates or more closely auditing the provision of services. And that’s what we want to focus on today: what rights do states have under federal Medicaid law to audit the provision of services and collect overpayments? This is, to us, an interesting area of the law and one that at least one state Supreme Court has dealt with in the past
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Earlier this year, my colleague Ross Margulies and I told you about a new proposed rule issued by CMS that makes several changes to the Medicaid prescription drug rebate program, or the MDRP. Recently, CMS finalized the rule and we thought we’d take this opportunity to tell you about it. On balance, we think that the rule succeeds in CMS’s stated goals of increasing access to innovative health care therapies to Medicaid beneficiaries as well as clarifying some longstanding questions about the operation of the MDRP.