joe, Author at DeBrunner & Associates

Medicare Innovations Foster Focus on Behavioral Health

A number of recent changes in the Medicare program appear designed to make it easier for beneficiaries to pursue behavioral health assistance. Among them: A greater focus on the integration of physical and behavioral health. A greater willingness to pay for digital behavioral health interventions. The release of several requests for information addressing behavioral health services. The introduction of new behavioral health procedure and billing codes. The inclusion of behavioral health in new Medicare models, including the LEAD (Long-Term Enhanced ACO Design) Model, the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, and the MAHA ELEVATE (Make America Healthy [...]

joe2026-04-23T15:06:02-04:00April 27, 2026|ACO, Alternative payment models, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 23

The following is the latest health policy news from the federal government for April 17-23. Some of the language used below is taken directly from government documents. The White House President Trump has issued an executive order calling for accelerated access to medical treatments for patients with serious mental illness, with an emphasis on greater access to psychedelic drugs. Learn more from this executive order and an accompanying White House fact sheet. Shortly after the White House issued this executive order, HHS’s Advanced Research Projects Agency for Health (ARPA-H) announced the first set of research teams for its Evidence-Based Validation [...]

joe2026-04-23T16:43:24-04:00April 23, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicare, Medicare reimbursement policy|

Some States Step in to Help Offset Health Exchange Changes

Enhancing existing state subsidies to help pay health insurance premiums. Replacing lost premium tax credits. Reducing monthly premiums. Extending subsidies to some middle-income individuals and families. Mitigating the loss of eligibility for lawfully present immigrants. These are among the steps that some state governments have taken to try to offset the impact of changes in Affordable Care Act health exchange eligibility and insurance premium assistance that took effect on January 1. Learn more about these and other mostly one-year fixes from the Commonwealth Fund report “Some States Blunted the Impact of Lost Federal Marketplace Subsidies, But Efforts Will Be Hard [...]

joe2026-04-21T16:49:34-04:00April 22, 2026|Affordable Care Act|

CMS Introduces Next Step in Fighting Medicaid Fraud, Waste, and Abuse

In his agency’s latest attempt to identify and address Medicaid fraud, Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz has announced that states will have 30 days to submit to CMS a plan for revalidating all providers enrolled in their Medicaid programs. In explaining his rationale for this approach, Oz told participants at a recent event that "The basic thing you'd want to do, if you actually cared about the program, is to make sure that legitimate providers are providing services that you're paying for and doing it the right way… So we're asking the states to own [...]

joe2026-04-21T15:42:28-04:00April 22, 2026|Centers for Medicare & Medicaid Services, Medicaid|

Federal Health Policy Update for April 16

The following is the latest health policy news from the federal government for April 11-16. Some of the language used below is taken directly from government documents. CMS – New Proposed Regulations FY 2027 Medicare Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Proposed Rule CMS has published its proposed FY 2027 Medicare hospital inpatient and long-term-care hospital prospective payment system rule. The highlights of the proposed rule are: A 2.4 percent rate increase for both acute-care hospital inpatient and long-term care hospital services. A $564 million reduction in Medicare disproportionate share hospital (Medicare DSH) and [...]

joe2026-04-16T16:21:07-04:00April 16, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. During the course of the deliberations, MACPAC’s staff made the following presentations to the commissioners: Implementing Community Engagement Requirements in Medicaid State and Federal Tools for Ensuring Accountability of Medicaid Managed Care Plans: Draft Chapter Children and Youth with Special Health Care Needs (CYSHCN) Transitions to Adult Coverage: Draft Chapter and Recommendations Automation in the Prior Authorization Process: Draft Recommendations Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care for the Elderly: Policy Options Health and Welfare in Self-Directed [...]

joe2026-04-15T12:51:27-04:00April 16, 2026|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care|

MedPAC Meets

MedPAC’s commissioners held their latest public meeting on Thursday, April 9 and Friday, April 11. The subjects on the meeting’s agenda were: improving payment incentives in Medicare analysis of regional benchmarks and benchmark-plan availability in the Part D prescription drug plan market preferred networks and pharmacy access in Part D estimated association between Medicare Advantage enrollment and hospitals’ and post-acute care providers’ finances information sources that beneficiaries use to make Medicare enrollment decisions institutional special-needs plans: provision of services, network-adequacy requirements, and star ratings mandated report: assessment of the Medicare ground ambulance data collection system Go here for summaries of [...]

joe2026-04-15T08:18:40-04:00April 15, 2026|Medicare regulations, Medicare reimbursement policy|

Is CON on the Way OUT in Rural States?

The federal Rural Health Transformation Program may sound the death knell for certificate-of-need laws in some states. The rural funding program, created last year as part of H.R. 1, often referred to as the One Big Beautiful Bill Act, is a five-year, $50 billion program intended to offset some of the damage anticipated as a result of that law’s 10-year reduction in federal health care spending, and especially its Medicaid cuts, on rural health care. While every state that applied for funding through the program was awarded grants, the Centers for Medicare & Medicaid Services has indicated that approval of [...]

joe2026-04-10T14:27:33-04:00April 13, 2026|Centers for Medicare & Medicaid Services, Medicaid|

Federal Health Policy Update for April 10

The following is the latest health policy news from the federal government for April 4-10. Some of the language used below is taken directly from government documents. Congress The House and Senate were in recess this week and are scheduled to be back in session on April 14. House Speaker Mike Johnson (R-LA) has indicated that the House will not vote on the Senate‑passed Department of Homeland Security continuing resolution until there is meaningful progress on a reconciliation package to fund U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection. In an effort to narrow the scope [...]

joe2026-04-10T13:43:20-04:00April 10, 2026|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|

Insurer Use of Prior Authorization Down

The insurance industry appears to be making good on its pledge to reduce its use of prior authorization for services and to make that process simpler for providers and patients Last June, some of the leading health insurers agreed to work to address prior authorization challenges. Now, an AHIP-Blue Cross Blue Shield Association survey has found that they have reduced by 11 percent the number of procedures and services that require prior authorization, which translated into 6.5 million fewer requests. Medicare Advantage plans went even further, eliminating 15 percent of procedures and services that require prior authorization. In addition, the [...]

joe2026-04-08T13:38:49-04:00April 10, 2026|Uncategorized|

joe

About joe