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Pa. Loses $3M Medicaid Reimbursement Fight With HHS

July 26, 2018, 8:28 PM

Pennsylvania will have to return $3 million in Medicaid reimbursement to the Centers for Medicare & Medicaid Services because federal Medicaid funds can’t cover provider training costs.

The U.S. Court of Appeals for the Third Circuit July 25 ruled a State Medicaid Director Letter (SMDL), published in 1994, was an interpretive rule rather than a substantive rule and prohibited states from claiming provider training costs as part of the cost of administering a state’s Medicaid plan.

The state used the money to pay for training nursing home staff alternatives to using physical and chemical restraints on Medicaid patients.

The case...

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