joe, Author at DeBrunner & Associates

Federal Health Policy Update for May 21

The following is the latest health policy news from the federal government for May 15-21. Some of the language used below is taken directly from government documents. Congress The House Ways and Means Committee marked up several health care bills addressing issues such as durable medical equipment (DME) and home health fraud. A discussion draft that would have required non-profit hospitals and health systems to provide additional reporting on community benefit spending was removed from the list of measures considered. See all the marked-up bills and a recording of the meeting on the committee’s website here. Ways & Means expects [...]

joe2026-05-21T16:10:09-04:00May 21, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicaid managed care, Medicaid regulations, Medicare reimbursement policy|

HHS Examines Why Rural Hospitals Close

Why are rural hospitals closing at a much faster rate than their non-rural counterparts? The Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation recently explored this question with an intensive data-based approach that yielded the following conclusions about rural hospital closures between 2012 and 2023 (all bullets are direct quotes from the agency’s report): Rural hospitals face unique challenges that make them especially vulnerable to closure or conversion to outpatient-only facilities. While 8% of rural hospitals have closed or converted since 2010, only 3.5% of urban hospitals have done so during the same [...]

joe2026-05-20T09:01:47-04:00May 21, 2026|hospitals|

CMS Sets Final ACA Terms for 2027

The Centers for Medicare & Medicaid Services has issued its annual “Notice of Benefit and Payment Parameters for 2027; Basic Health Program,” which governs health plans offered through the federal health insurance exchange and state exchanges as established under the Affordable Care Act. Major provisions under the new final rule include: Eliminating the current requirement that insurers offer standardized health plans at each of the traditional plan levels (bronze, silver, gold, and platinum) in favor of permitting insurers to offer unlimited numbers of plans at each level. Introducing a new non-network plan option in which insurers can now offer exchange [...]

joe2026-05-20T08:07:00-04:00May 20, 2026|Affordable Care Act|

MACPAC Seeks Guardrails for AI Use in Medicaid Prior Authorization

While acknowledging the potential value of the use of AI in facilitating Medicaid prior authorization decisions, the agency that advises Congress on Medicaid and Children’s Health Insurance Program policy will recommend to Congress that the programs erect guardrails to protect those they serve. During a recent meeting of the Medicaid and CHIP Payment and Access Commission, members of that group discussed a staff report on the use of AI in Medicaid prior authorization decisions and endorsed the following principles for the use of AI in this manner: The Secretary of the U.S. Department of Health and Human Services should direct [...]

joe2026-05-13T12:04:25-04:00May 15, 2026|MACPAC, Medicaid, Medicaid managed care|

Federal Health Policy Update for May 14

The following is the latest health policy news from the federal government for May 8-14. Some of the language used below is taken directly from government documents. Congress The Ways and Means Committee has circulated a discussion draft of a bill that would require non-profit hospitals and health systems to report more of their community benefit-related spending activity. Under the draft bill, non-profit hospitals and health systems would be required to report on charity care spending, their process for patients to apply for financial assistance, and spending associated with community benefits. They also would be required to report on subsidized service lines, community health needs assessments, and more. Affected hospitals and health [...]

joe2026-05-14T15:39:30-04:00May 14, 2026|hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and housing for the disabled, Medicaid managed care, Medicare, Medicare reimbursement policy|

A Closer Look at the Proposed Drug Prior Authorization Regulation

Last month, the Centers for Medicare & Medicaid Services proposed new requirements for the prior authorization of drugs for patients served by Medicare Advantage, Medicaid, CHIP, and qualified health plans in the federal marketplace. This proposal represented a next step to requirements CMS laid out in 2024 when it called on payers to offer electronic prior authorization for medical services and to respond to providers within required timeframes: seven days for standard requests and 72 hours for expedited requests. Now, CMS proposes requiring these payers to meet these standards through electronic prior authorization for drugs covered under their plans’ pharmacy [...]

joe2026-05-12T17:18:03-04:00May 14, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare|

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: Automation in Medicaid Prior Authorization: Recommendations Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care for the Elderly: Recommendations and Updated Implications Appropriate Access to Residential Services for Children and Youth with Behavioral Health Needs: Recommendations Implementing Community Engagement Requirements in Medicaid: Recommendation and Updated Implications Children and Youth with Special Health Care Needs Transitions to Adult Coverage: Recommendations and Updated Implications Click the [...]

joe2026-05-12T14:55:54-04:00May 13, 2026|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and housing, Medicaid and housing for the disabled, Medicaid regulations for the disabled|

Hospital at Home Proving its Worth?

A new study suggests that hospital at home programs are producing positive results for patients and the health care system. Positive results such as greater comfort for patients, fewer returns to the hospital emergency department within 30 days of discharge, lower in-hospital mortality, reduced costs, and improved outcomes. Serving patients at home also frees hospital beds for sicker patients – an important consideration in communities where hospital occupancy levels are especially high. In hospital at home programs, patients receive acute-care services in their own homes with the help of remote monitoring and home visits by clinicians. One downside so far: [...]

joe2026-05-07T16:56:22-04:00May 12, 2026|hospitals, Medicare, Uncategorized|

The Latest CMS Efforts on Prior Authorization

The Centers for Medicare & Medicaid Services continues to work tackling the challenges posed by health insurers that insist they will not pay for certain medical services unless they authorize those services beforehand. In a new blog post, CMS Administrator Mehmet Oz reviews past, current, and future agency efforts to address the challenges posed by the need to obtain prior authorization for medical services. The latest such step, he notes, is adding electronic prior authorization to the Health Tech Ecosystem. Under this approach, work groups across the spectrum of stakeholders seek to align CMS Interoperability and Prior Authorization Final Rule [...]

joe2026-05-07T14:16:35-04:00May 11, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare|

Federal Health Policy Update for May 7

The following is the latest health policy news from the federal government for May 1-7. Some of the language used below is taken directly from government documents. Congress Congress hopes to pass a reconciliation package to fund Immigration and Customs Enforcement (ICE) and Customs and Border Protection before June 1; lawmakers would then turn to a potential third reconciliation measure to address health care affordability before the mid-term elections. Health care provisions in a potential third reconciliation bill could include expanded access to health savings accounts (HSAs); changes to the rate at which the federal government matches state Medicaid spending [...]

joe2026-05-07T16:06:32-04:00May 7, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

joe

About joe