joe, Author at DeBrunner & Associates

Federal Health Policy Update for December 18

The following is the latest health policy news from the federal government for December 12-18. Some of the language used below is taken directly from government documents. Congress In a 216-211 vote yesterday, the House passed the Lower Health Care Premiums for All Americans Act, a Republican package aimed at addressing multiple health care policies. The legislation includes provisions for employee tax-advantaged benefits like HSAs and FSAs, cost-sharing reductions (CSR) subsidies, and increased transparency requirements for pharmacy benefit managers (PBMs). It notably did not include an extension of the enhanced Affordable Care Act premium tax credits that many of the [...]

joe2025-12-18T16:29:43-05:00December 18, 2025|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Controversy Over No Surprises Act Continues

Providers and payers continue to wage war over how the No Surprises Act is being implemented. The law, enacted in 2020, was intended to prevent insured consumers from receiving surprise medical bills, especially for out-of-network care. While it has achieved that objective to a considerable degree, it has left behind providers complaining they are being underpaid for their services and payers – health insurers – insisting that the process of adjudicating such disputes, through what is known as the Independent Dispute Resolution process, is forcing them to pay far too much for providers’ services. At the heart of the debate [...]

joe2025-12-17T12:57:49-05:00December 18, 2025|Uncategorized|

Hospital Bad Debt and Charity Care Rising

Hospital bad debt and charity care are rising, according to a new report. Both are up five percent from October of 2024 to October of 2025 – and 40 percent greater than in 2022. Among the causes are natural demographic changes and post-COVID Medicaid redeterminations, the latter of which is leaving many low-income Americans without health insurance. The impact of rising bad debt and charity care are being felt most in the western U.S. And one bright spot: charity care and bad debt as a percentage of hospital gross revenue fell two percent between October of 2024 and October of [...]

joe2025-12-16T16:30:49-05:00December 17, 2025|hospitals, Medicaid|

Hospitals Shedding Pediatric Services

More and more hospitals are shedding their less profitable pediatric services, a review of 20 years of hospital activity has revealed. Driven by a combination of staffing issues and low Medicaid payments, hospitals are increasingly closing some of their pediatric services, according to a review in the journal Pediatrics, which found that Among more than 3000 US hospitals, 26.7% provided minimal pediatric services in 2003, which increased to 65.0% in 2022… Learn more about the challenges hospitals face in providing care for children and the impact of 20 years of decline in hospitals’ ability to provide such care from the [...]

joe2025-12-11T15:27:48-05:00December 15, 2025|hospitals, Medicaid|

Federal Health Policy Update for December 11

The following is the latest health policy news from the federal government for December 5-11. Some of the language used below is taken directly from government documents. Congress The Senate voted today on competing proposals to address health care affordability: Democrats sought a clean extension of the Affordable Care Act premium tax credits set to expire on December 31 while Republicans tried to consolidate support around an alternative plan. Neither bill gained the 60-vote threshold needed for passage. In the House, Speaker Mike Johnson (R-LA) intends to bring a vote on a health care package next week but at this [...]

joe2025-12-11T15:48:53-05:00December 11, 2025|Affordable Care Act, Alternative payment models, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

CMS Fleshes Out Medicaid Work Requirement

The Centers for Medicare & Medicaid Services has issued additional guidance to the states on how to implement the work and community engagements established as part of the criteria for Medicaid eligibility under H.R. 1, commonly known as the One Big Beautiful Bill Act, which was signed into law in July. The requirements seek to connect able-bodied, working-age adults with work and community engagement activities and reduce inappropriate Medicaid enrollment. The states are required to implement these requirements by January 1, 2027 but may do so sooner if they wish. In providing this guidance, CMS enumerates four major principles, quoted [...]

joe2025-12-10T12:57:33-05:00December 11, 2025|Centers for Medicare & Medicaid Services, Medicaid|

MedPAC Discusses Preliminary 2027 Rate Recommendations

The members of the Medicare Payment Advisory Commission met virtually last week and reviewed and discussed preliminary proposals for 2027 Medicare rates and other Medicare payment issues. Leading the agenda for the two days of meetings was a review of the adequacy of current Medicare payments and discussion about rate 2027 rate recommendations for: hospital inpatient and outpatient services physician and other health professional services inpatient rehabilitation facility services skilled nursing facility services home health care services hospice services outpatient dialysis services MedPAC members also discussed: their mandated report on rural emergency hospitals an update on site-neutral payments, including the [...]

joe2025-12-10T08:11:11-05:00December 10, 2025|Congress, hospitals, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Urban Safety-Net Hospitals Most Vulnerable to Looming Health Care Cuts

While a great deal of attention has been paid to the potential implications for rural hospitals of the coming $1 trillion in federal health care spending cuts over the next decade, it turns out that urban safety-net hospitals, not rural hospitals, may be even more vulnerable to the effects of these cuts. According to an analysis by the New York Times and Harvard’s T.H. Chan School of Public Health, of the 109 hospitals in the country that will be most vulnerable to these cuts, 85 percent are urban safety-net hospitals and not rural hospitals. Three factors drive this vulnerability: their [...]

joe2025-12-04T16:51:55-05:00December 8, 2025|Congress, hospitals, Medicaid|

Federal Health Policy Update for December 4

The following is the latest health policy news from the federal government for November 21 through December 4. Some of the language used below is taken directly from government documents. Congress Congress is back in session to discuss the Affordable Care Act tax credits set to end on December 31and other extenders that will expire on January 30, 2026 along with the latest continuing resolution (CR). Members continue to negotiate potential solutions to the expiring enhanced Affordable Care Act premium subsidies but there is no consensus on whether or how to address the expiring benefit. Senate Majority Leader Thune (R-SD) [...]

joe2025-12-04T15:05:28-05:00December 4, 2025|340b, Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

CMS Offers Preliminary Thoughts on Medicaid Provider Taxes

In a message to state Medicaid programs, the Centers for Medicare and Medicaid Services has laid preliminary groundwork for how it intends to interpret new limits on Medicaid provider taxes enacted under H.R. 1, a law passed in July that brought significant changes to U.S. tax law and major changes in Medicare and especially Medicaid; the bill also has become known as the “One Big Beautiful Bill Act.” With all but one state using Medicaid provider taxes to help finance their share of Medicaid spending and many states increasingly dependent on such taxes, this issue is of considerable importance to [...]

joe2025-11-20T16:05:02-05:00November 24, 2025|Medicaid, Medicaid regulations|

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