joe, Author at DeBrunner & Associates

Federal Health Policy Update for August 28

The following is the latest health policy news from the federal government for August 22-28. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess and will return to Washington D.C. on September 2. Funding for the federal government expires on September 30, as will a number of health care extenders, including for telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to reductions to Medicaid disproportionate share (Medicaid DSH) allotments. Congressional Budget Office (CBO) The CBO has written to congressional [...]

joe2025-08-28T15:48:29-04:00August 28, 2025|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

New Committee to Consider Federal Role in Health Care

The Department of Health and Human Services and Centers for Medicare & Medicaid Services are forming a new committee to “restore patient-driven care.” The group, to be called the “Federal Healthcare Advisory Committee,” will consist of “… experts charged with delivering strategic recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz to improve how care is financed and delivered across Medicare, Medicaid and the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace.” As described in a CMS news release, the scope of the committee’s work will encompass: Actionable policy initiatives to promote [...]

joe2025-08-21T16:38:27-04:00August 25, 2025|Centers for Medicare & Medicaid Services, health care reform, Medicaid, Medicare|

Federal Health Policy Update for August 21

The following is the latest health policy news from the federal government for August 15-21. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess and will return to Washington D.C. on September 2. Funding for the federal government expires on September 30, as will a number of health care extenders, including for telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments. In the fall, Congress is considering pursuing health care legislation along two [...]

joe2025-08-21T14:43:11-04:00August 21, 2025|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare reimbursement policy, post-acute care, Telehealth|

Potential Implications of the One Big Beautiful Bill Act

The publication Health Affairs has published a number of newsletters and articles about the so-called One Big Beautiful Bill and its potential implications for consumers and providers. To learn more, see the following pieces: “The BBB: Consumer Choice and Market Competition” “The Budget Bill’s Impact on Immigrant Access to Health Care” “The 'One Big Beautiful Bill,' Now Law, Does Not Protect Rural Hospitals” “With Budget Reconciliation Bill Enacted, Health Care Changes Loom” “The Big Beautiful Bill: A New Era for Health Policy? w/ Katie Keith” “Trump's Deregulation Era & The Big Budget Reconciliation's Health Care Impact w/ Katie Keith” Subscriptions [...]

joe2025-08-19T15:27:30-04:00August 21, 2025|Congress, hospitals|

Putting Some Meat on CMS’s WISeR Bones

In June, the Centers for Medicare & Medicaid Services announced a new CMS Innovation Center model: The Wasteful and Inappropriate Service Reduction Model, or WISeR. The idea behind WISeR is for Medicare to seek to reduce waste, fraud, and abuse in the program by working through technology companies to make greater use of prior authorization and pre-payment reviews for a small group of medical items and services that the agency considers susceptible to misuse or unnecessary use. While the program is scheduled to start next January 1 and CMS has chosen a limited number of states – Arizona, New Jersey, [...]

joe2025-08-20T12:50:03-04:00August 20, 2025|Center for Medicare and Medicaid Innovation, CMMI, Medicare, Medicare reimbursement policy|

The Likelihood of Major Medicare Cuts

While the potential for significant Medicaid cuts resulting from passage of the FY 2025 federal budget reconciliation bill – the so-called One Big Beautiful Bill – has received a great detail of attention, the possibility of Medicare cuts as well has flown mostly under the radar. Until now. In a letter to Democratic congressional committee leaders, the Congressional Budget Office has put a price tag on prospective Medicare cuts. According to the CBO, the FY 2025 budget reconciliation bill could lead to more than $500 billion in federal Medicare payment cuts between next year and 2034. The federal “PAYGO” law [...]

joe2025-08-19T14:06:16-04:00August 20, 2025|Medicaid, Medicare, Medicare reimbursement policy|

Survey Looks at Prior Authorization in Medicaid

A recently published study takes a closer look at the state of prior authorization practices in state Medicaid managed care programs. The survey explored prior authorization decision time frames, the use of electronic denial notices, patient access to external medical review, and processes and time frames for prior authorization decisions and appeals based on federal Medicaid managed care rules. Among the survey’s findings: “Nearly half of responding states (17 of 36) reported requiring standard prior authorization decisions within 7 calendar days (18 states) or a shorter timeframe (9 states). “About one-third of responding MCOs [managed care organizations] (12 of 38) [...]

joe2025-08-14T15:04:40-04:00August 18, 2025|Medicaid, Medicaid managed care|

Federal Health Policy Update for August 14

The following is the latest health policy news from the federal government for August 8-14. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess and will return to Washington D.C. on September 2. Funding for the federal government, along with health care extenders including extensions of telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments, all expire September 30. In the fall, Congress is considering pursuing health care legislation along two tracks, [...]

joe2025-08-14T15:35:41-04:00August 14, 2025|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare post-acute care, Medicare reimbursement policy, Telehealth|

Potential Medicaid Implications of the “One Big Beautiful Act”

Growing uncompensated care. Service cuts. Reduced access to care, especially in rural areas. Expansion projects placed on hold. These are among the potential implications of the Medicaid cuts included in the recently passed FY 2025 budget reconciliation bill, often referred to as the “One Big Beautiful Act.” A significant portion of those cuts will come through limits on state directed payments: supplemental Medicaid payments proposed by the states and approved by the federal government to selected providers for high-cost, high-demand, low-payment services delivered through Medicaid managed care plans. The new law limits future use of this mechanism and may, in [...]

joe2025-08-12T16:55:13-04:00August 13, 2025|hospitals, Medicaid, Medicaid managed care|

Coming Soon: The Rural Health Transformation Program

Federal health care officials are getting ready to bring the FY 2025 budget reconciliation bill’s “Rural Health Transformation Program” to life. Added to the “One Big Beautiful Bill” to provide assistance to rural hospitals that maintained that their existence would be jeopardized by the Medicaid cuts and other health care changes in the law, the Rural Health Transformation Fund will consist of $50 billion to be distributed to rural health care organizations over a five-year period. Half of that money will go to states that successfully apply it – the Department of Health and Human Services can reject states’ applications [...]

joe2025-08-07T17:03:39-04:00August 11, 2025|hospitals, Medicaid|

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