cutive and non-consecutive days) are eligible to file suit. This includes veterans, family members, non-military workers (civilian contractors), and any others (in utero) who were exposed to the contaminated water between the listed dates.What isn't as obvious—and what we hope to clarify here—is if and how filing suit under the Justice Act may impact the continued receipt of other government benefits.The pertinent provision of the Justice Act reads:(2) Health and disability benefits relating to water exposure--Any award made to an individual, or legal representative of an individual, under this section shall be offset by the amount of any disability award, payment, or benefit provided to the individual, or legal representative--(A) under--(i) any program under the laws administered by the Secretary of Veterans Affairs;(ii) the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); or(iii) the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and(B) in connection with health care or a disability relating to exposure to the water at Camp Lejeune.PACT Act § 804(e)(2).Let's unpack this. At its core, the provision is designed to prevent double dipping, i.e., allowing an individual to recoup twice for the same injury. Thus, when it is implicated, the provision will serve to reduce or offset any eventual monetary award by the sum of government benefits already received for related health or disability issues.What it does not do is prohibit or prevent any exposed individual (or their legal representative) from filing a lawsuit in the first instance. Nor does it jeopardize the continued receipt of related government benefits.In fact, several things must be true for the provision to be triggered. First, this provision only applies if an individual has already been receiving government benefits in connection with health care or a disability relating to exposure to the contaminated water at Camp Lejeune. Second, the provisi

cutive and non-consecutive days) are eligible to file suit. This includes veterans, family members, non-military workers (civilian contractors), and any others (in utero) who were exposed to the contaminated water between the listed dates.What isn't as obvious—and what we hope to clarify here—is if and how filing suit under the Justice Act may impact the continued receipt of other government benefits.The pertinent provision of the Justice Act reads:(2) Health and disability benefits relating to water exposure--Any award made to an individual, or legal representative of an individual, under this section shall be offset by the amount of any disability award, payment, or benefit provided to the individual, or legal representative--(A) under--(i) any program under the laws administered by the Secretary of Veterans Affairs;(ii) the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); or(iii) the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and(B) in connection with health care or a disability relating to exposure to the water at Camp Lejeune.PACT Act § 804(e)(2).Let's unpack this. At its core, the provision is designed to prevent double dipping, i.e., allowing an individual to recoup twice for the same injury. Thus, when it is implicated, the provision will serve to reduce or offset any eventual monetary award by the sum of government benefits already received for related health or disability issues. What it does not do is prohibit or prevent any exposed individual (or their legal representative) from filing a lawsuit in the first instance. Nor does it jeopardize the continued receipt of related government benefits. In fact, several things must be true for the provision to be triggered. First, this provision only applies if an individual has already been receiving government benefits in connection with health care or a disability relating to exposure to the contaminated water at Camp Lejeune. Second, the provi

”Federal Preemption. No fine, whether discretionary or mandatory, may be imposed against any nursing facility, nursing home, or intermediate care facility which is subject to intermediate sanctions under the provisions of 42 U.S.C. § 1396 r(h)(2)(A), as amended, whether or not those sanctions actually are imposed.Authorizes the department to deny an application when an applicant has surrendered a license within the prior year in order to “avert denial, revocation, or suspension of a license or payment of fines.”Written comments on the proposed changes are due on or before March 5, 2021. DCH is expected to propose additional regulations to implement the remaining statutory changes made as a result of HB987.

Appellants offered two bases to invalidate the regulation. First, they claimed, the regulation violated Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq. Judge Messano did not agree.

It is understood, however, that members of Congress will continue to push for IMD reform and it is expected to remain a legislative priority of the Bi-Partisan Heroin Task Force.Notes [1] The Medicaid program is paid for through shared state and federal funding. See 42 U.S.C. § 1396 (establishing the Medicaid program). FFP is the federal portion.

Going forward, fines will continue to rise as the Federal Civil Penalties Inflation Adjustment Act of 1990 (“Inflation Adjustment Act”) requires agencies to revisit penalty ranges annually. For Medicaid providers subject to the federal Deficit Reduction Act of 2005 (DRA), codified in 42 U.S.C. § 1396(a)(68), this civil monetary penalty adjustment carries an additional burden. For any entity or provider that receives or makes payments under a state Medicaid plan of at least $5 million per year, the DRA requires that the provider or entity educate its employees, contractors and agents concerning federal and state false claims act provisions, penalties and protections.

The federal Medicaid program allows such arrangements, but requires that capitation payments by states be “actuarially sound.” 42 U.S.C. § 1396(m)(2)(A). In particular, managed-care contracts must be certified by an actuary using standards established by the Actuarial Standards Board, a non-governmental trade organization.

11For states to remain eligible to receive bonuses on Medicaid-related false claims recoveries under section 1909 of the Social Security Act, federal law requires, in part, that "the [state] law contains provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims" as the FFCA. 42 U.S.C. §1396(h).12 California Assembly Bill 2492 (amending Cal. Gov't Code §12650(b)(1)(B)).13 California Assembly Bill 2492 (amending Cal.

The case originated as multiple challenges by California Medicaid providers and beneficiaries to Medicaid payment cuts passed by the state legislature in 2008 and 2009. The challengers claimed that those California statutes should be void under the Constitution’s Supremacy Clause, because they violated a provision of federal Medicaid statutes (42 U.S.C. § 1396(a)(30)(A)) which requires a state’s Medicaid state plan to provide payments that “are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers” to supply adequate Medicaid services. [BREAK]The Ninth Circuit agreed with the plaintiffs and issued preliminary injunctions against implementation of the payment cuts.