joe, Author at DeBrunner & Associates

GLP-1 Model Popular Among Seniors

It looks like a lot of seniors want help losing weight. That seems like a reasonable conclusion after a Department of Health and Human Services official told a recent gathering that more than one million Medicare beneficiaries have signed up to participate in Medicare’s GLP-1 Bridge Model, which will temporarily reduce the price of the popular weight-loss drug to $50 a month. The program, which operates outside of Medicare Part D plans, is intended to serve as a bridge to CMS’s broader BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model, which was delayed while CMS continues to [...]

joe2026-10-15T14:55:26-04:00October 16, 2026|Medicare|

Federal Health Policy Update for October 15

Don’t Miss: IRS proposes changes in rules governing ACA premium tax credits Lawsuit and legislation aim to block 340B Rebate Model Program CMS updates telehealth FAQ The following is the latest health policy news from the federal government for October 9-15. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will reconvene after the mid-term elections on November 9. Upon their return, one of their priorities will be advancing a government funding package because the current continuing resolution (CR) expires on December 11. Affordable Care Act Premium Tax Credits The IRS has [...]

joe2026-10-15T16:58:25-04:00October 15, 2026|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

The Curious Case of Improper Medicaid Payments

While the Centers for Medicare & Medicaid Services continues its efforts to “crush” Medicaid fraud, a new report says that the biggest source of improper Medicaid payments is… Flawed paperwork. While improper payments generally are categorized as fraud, waste, and abuse, CMS’s focus has been squarely on fraud. At the same time, however, the Congressional Research Service recently reported that flawed paperwork, and not necessarily an attempt to inappropriately or illegally profit from Medicaid payments, is most of the problem. According to the report, CMS estimates that most improper payments (77% in FY2025) are the result of insufficient documentation (e.g., [...]

joe2026-10-14T11:32:26-04:00October 15, 2026|Medicaid|

MedPAC Meets

Members of the Medicare Payment Advisory Commission held their latest public meeting on Thursday, October 8 and Friday, October 9. The subjects on the meeting’s agenda were: Issues affecting the payment accuracy of the physician fee schedule and the clinical laboratory fee schedule Clinician quality initiatives in fee-for-service Medicare Medicare’s late-enrollment penalties Workplan: assessing the accuracy of the skilled nursing facility and home health prospective payment systems Go here for a summary of each of these issues, key points, future action items, and links to MedPAC staff presentations. MedPAC is an independent congressional agency that advises Congress on issues involving [...]

joe2026-10-13T15:02:45-04:00October 14, 2026|Medicare, MedPAC|

Federal Health Policy Update for October 8

Don’t Miss: Latest 340B developments CMS penalizes majority of hospitals for failing to meet Readmissions Reduction Program standards FTC reminds hospitals of price transparency requirements The following is the latest health policy news from the federal government for October 2-8. Some of the language used below is taken directly from government documents. The White House The White House announced that the federal government will make one-time payments of $90 per person to more than 20 million Medicare enrollees – about one-third of Medicare participants – to help them pay their Medicare Part B premiums. Most eligible seniors will receive the [...]

joe2026-10-08T16:40:19-04:00October 8, 2026|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for October 1

Don’t Miss: CMS partners with 37 states to launch Medicaid quality initiative CMS fleshes out GLOBE Model Medicare Part D Claims Data 340B Repository goes live The following is the latest health policy news from the federal government for September 25 - October 1. Some of the language used below is taken directly from government documents. The White House A statement issued by the White House titled “President Trump Takes Historic Action to Eliminate Wasteful and Harmful Spending” includes a series of cuts, or rescissions, of health-related federal expenditures, including $567 million for taxpayer-funded HHS services for non-citizens; $28 million [...]

joe2026-10-07T11:45:36-04:00October 1, 2026|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. The following is MACPAC’s own summary of the meeting: MACPAC’s September 2026 meeting began with a discussion around community engagement (CE) requirements in Medicaid. The 2025 Budget Reconciliation Act established CE requirements and delegates to the Secretary the authority to set certain standards and procedures that the Centers for Medicare & Medicaid Services (CMS) addressed in the interim final rule with comment (IFC), issued on June 1, 2026. Staff summarized key IFC provisions, including individuals subject to CE, exceptions and exclusions from CE, state [...]

joe2026-09-30T11:58:20-04:00October 1, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid regulations|

Imminent Changes in Medicaid Eligibility for Immigrants

Come October 1, immigrants seeking Medicaid benefits – including lawful immigrants – will face a new array of eligibility criteria and requirements. KFF has presented a broad look at those new criteria, ushered in as a result of last year’s federal budget reconciliation bill – also known as H.R. 1 and the One Big Beautiful Act Bill – and how they are expected to be implemented. The major aspects of the coming changes are (all quoted directly from the KFF review): States must redetermine eligibility for all “potentially affected” existing Medicaid enrollees under the new rules by October 1, 2026, [...]

joe2026-09-30T08:25:08-04:00September 30, 2026|Medicaid|

Federal Health Policy Update for September 24

Don’t Miss: CMS plans major cuts in Medicare clinical lab payments Administration reconsiders shifting NIH grant decisions to White House All states enroll in CMS model to reduce prices of selected Medicaid-covered drugs The following is the latest health policy news from the federal government for September 18-24. Some of the language used below is taken directly from government documents. The White House The White House has issued the executive order “Enhancing Program Integrity and Interagency Coordination in the Administration of the H-1B Nonimmigrant Visa Program.” The order increases federal oversight of the H-1B visa program because “The abuse of [...]

joe2026-09-24T15:28:11-04:00September 24, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|

Where Have All the Nursing Home Beds Gone?

Across the country, the supply of nursing homes is dwindling. Nationally, the Centers for Medicare & Medicaid Services reports 900 fewer certified nursing homes in 2025 than in 2015. Why the decline? The most commonly cited reason is inadequate payments from Medicaid, the leading payer for nursing home care, which generally pays less than the daily cost of care. Another is staffing: nursing home jobs pay poorly and are considered stressful, making it difficult to attract and retain staff. Even the erosion in the number of beds may not completely capture the decline in access to skilled nursing care. More [...]

joe2026-09-24T08:44:20-04:00September 24, 2026|Uncategorized|

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