joe, Author at DeBrunner & Associates

Federal Health Policy Update for November 5

Don’t Miss: CMS releases final 2027 Medicare outpatient rule CMS releases final 2027 Medicare physician fee schedule rule New guidance for batching IDR claims The following is the latest health policy news from the federal government for October 30-November 5. Some of the language used below is taken directly from government documents. 2026 Midterm Elections Democrats regained control of the House and Senate in the 2026 midterm elections. As of 3:30 p.m. eastern time today, the House is 251-155 and the Senate 54-44, both in favor of Democrats, with the outcome of 29 House races and two Senate [...]

joe2026-11-05T17:13:24-05:00November 5, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, 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 two days of meetings. MACPAC’s October 2026 meeting began with a staff presentation on findings from a literature review on factors that drive hospital costs. MACPAC discussed the Medicaid payment methodologies used for inpatient and outpatient hospital services and clarified the distinction between hospital cost, defined as the resources that hospitals expend to provide care, and Medicaid hospital spending, defined as the payments Medicaid makes for those services. Next, staff provided background on the Medicaid [...]

joe2026-11-05T09:04:06-05:00November 5, 2026|hospitals, MACPAC, Medicaid, Medicaid regulations for long-term care|

What the Changing of the Guard May Bring for Health Care

Medicare for all? A reversal of 2025-enacted cuts in Medicaid eligibility. The restoration of some Affordable Care Act health premium subsidies? More drug price negotiations between the federal government and pharmaceutical companies? The restoration of some National Institutes of Health research funding? A closer look at No Surprises Act dispute adjudication? These are among the policy initiatives that may be undertaken next year in the wake of the outcome of the mid-term elections that saw Democrats gain majorities in both the House and Senate next years? Learn more about some of the policy possibilities for the 120th Congress from [...]

joe2026-11-04T11:01:33-05:00November 4, 2026|Affordable Care Act, Congress, Medicaid, Medicare|

Federal Health Policy Update for October 29

Don’t Miss: CMS charts new path for pursuing ACA premium tax credits CMS publishes timeline for implementation of Medicaid changes Court rejects narrow “medically frail” definition for exemption from Medicaid work requirement Inspector General elaborates on new CMS “power to exclude” The following is the latest health policy news from the federal government for October 23-29. Some of the language used below is taken directly from government documents. Congress The House Committee on Oversight and Government Reform announced an investigation into pharmacy benefit managers (PBMs). In letters to CVS Caremark, Express Scripts, and Optum Rx, Chairman James Comer (R-KY) [...]

joe2026-10-29T17:09:21-04:00October 29, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

IRS Lays Groundwork for Changes in ACA Premium Tax Credits

The Internal Revenue Service has started the process for redefining who will be eligible for future health insurance premium tax credits for Affordable Care Act health exchange insurance policies. In a recently published notice, the IRS proposes bringing access to those premium tax credits into line with changes adopted in the FY 2025 reconciliation law that introduced major changes in Medicaid eligibility, Affordable Care Act health insurance premium subsidies, and other aspects of federal health care policy. The proposed rule would establish stricter eligibility and enrollment requirements for health premium subsidies – including work/community engagement requirements, income criteria, and immigration [...]

joe2026-10-15T15:42:56-04:00October 19, 2026|Affordable Care Act|

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|

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