On Friday, August 13, 2021, a panel of the D.C. Court of Appeals held that Medicare Advantage private insurers must return potentially billions of dollars in overpayments they receive based on incorrect diagnoses. 

The COVID-19 pandemic has made providing Medicaid services more challenging for human services agencies. For example, agencies are working hard to serve communities when physical locations are often required to close temporarily. During the pandemic, homes of service recipients can be significantly isolating as well, and individuals often need to move their residence to another location where others are available to accompany and care for them.

The concept of person-centered planning has been at play for decades, yet the publication of the Home and Community-based Services (HCBS) Settings Final Rule (“Final Rule”) in 2014 was the first time person-centeredness was explicitly tied to ongoing funding of home and community-based settings under the various Medicaid waiver authorities. As states work to comply with the Final Rule, agencies and service providers should embrace the important role they play in a state’s ability to make the shift to person-centeredness.

On Friday, September 25, 2020, the U.S. District Court for the Northern District of Illinois held that the Centers for Medicare and Medicaid Services (CMS) improperly disallowed claims for $140 million in Medicaid reimbursements, because the method used by Illinois to adjust the particular payments was a reasonable interpretation of the Illinois state Medicaid plan.