joe, Author at DeBrunner & Associates

Court Rejects No Surprises Act’s QPA Methodology

A federal appeals court has rejected how health care payers calculate their qualifying payment amount, or QPA, when addressing disputed payments under the No Surprises Act’s Independent Dispute Resolution process. The QPA is the central benchmark rate payers present to help settle out-of-network medical billing disagreements that for years led to surprise medical bills for many hospital patients. The court concluded that payers should not be permitted to include so-called ghost rates when calculating their QPA; a ghost rate is a rate for services that a given provider does not actually provide, leaving the provider no incentive to attempt to [...]

joe2026-08-13T15:13:04-04:00August 14, 2026|Uncategorized|

Federal Health Policy Update for August 13

Don’t Miss: Federal court vacates key aspect of No Surprises Act’s IDR process President calls for changes in childhood immunizations CMS seeks billing info so it can pay APM docs their bonuses The following is the latest health policy news from the federal government for August 7-13. Some of the language used below is taken directly from government documents. The White House The White House has issued an executive order calling for a change in recommended childhood vaccines. The order suggests reducing the number of recommended childhood vaccines from the current 17 to 11 revising the status of the remaining [...]

joe2026-08-13T14:39:23-04:00August 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

CMS Clarifies Upcoming IDR Changes

Earlier this year, the departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management published federal Independent Dispute Resolution operations final rules to improve the functioning of the No Surprises Act’s IDR process, which is part of a broader effort to eliminate surprise medical bills. The new rules seek to streamline communication between health care payers, providers, and certified IDR entities by establishing new timelines and processes. When the individual requirements in these final rules will take effect will vary depending on when the technical capacity to support them is ready within the not-yet-introduced [...]

joe2026-08-12T13:05:25-04:00August 13, 2026|Uncategorized|

Disagreement Over 340B’s Future

Almost immediately after the Department of Health and Human Services announced a pilot program to test using a rebate model in the 340B Drug Pricing Program, members of Congress responded with proposed legislation that would prevent HHS from implementing that pilot. Last week, HHS’s Health Resources and Services Administration announced its 340B Rebate Model Pilot Program, a refined version of a previous pilot program that a federal court rejected earlier this year. Under this new model, qualifying drug manufacturers will be able to provide the 340B ceiling price to eligible 340B providers through rebates, an approach manufacturers have increasingly sought, [...]

joe2026-08-11T15:58:28-04:00August 12, 2026|340b, hospitals|

HRSA Tries Again With New 340B Model

Following a federal court rejection earlier this year of a previously announced pilot program to alter how the 340B Drug Pricing Program is administered, the Department of Health and Human Services’ Health Resources and Services Administration has announced that it will implement a revised 340B Rebate Model Pilot Program. Under this new model, qualifying drug manufacturers will be able to provide the 340B ceiling price to eligible 340B providers through rebates, an approach manufacturers have increasingly sought, rather than the upfront discounts that providers prefer. According to a HRSA news release, the agency believes its new model will: Improve claims-level [...]

joe2026-08-06T15:15:39-04:00August 10, 2026|340b|

Loss of Insurance Options Hitting Hospital Bottom Lines

Hospitals are starting to feel the impact of the loss of enhanced subsidies for the purchase of Affordable Care Act health insurance plans. According to officials from a number of for-profit hospital companies, they have been surprised at how few patients who lost their Affordable Care Act enhanced premium subsidies have purchased alternative coverage, leaving them uninsured instead. Nearly three million fewer people purchased insurance through Affordable Care Act exchanges this year than last year. Such individuals continue to turn to hospitals for care – increasingly, for care they put off because they were uninsured, resulting in greater acuity. Hospitals [...]

joe2026-08-05T12:54:53-04:00August 7, 2026|Affordable Care Act, hospitals|

Federal Health Policy Update for August 6

Don’t Miss: CMS issues final FY 2027 Medicare inpatient payment regulation HRSA introduces revised 340B rebate model CMS gives states new tool to help identify non-citizen Medicaid applicants The following is the latest health policy news from the federal government for July 31 to August 6. Some of the language used below is taken directly from government documents. Congress The Senate is expected to vote on its version of a continuing resolution (CR) before leaving for recess; it would extend federal government funding through December 11. Notably, the legislation includes language that would prevent the Office of Management and Budget [...]

joe2026-08-06T17:32:05-04:00August 6, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

More Medicaid DSH Money Coming for Some Hospitals?

Some hospitals may be in line for larger Medicaid disproportionate share hospital payments as a result of a federal court decision that calls for changes in how those Medicaid DSH payments are calculated. Last week, a U.S. District court in Texas again vacated a 2023 Centers for Medicare & Medicaid Services regulation that excludes inpatient days covered by uncompensated care pools, such as through section 1115 waivers, when quantifying Medicaid days for the purpose of calculating hospitals’ Medicaid DSH payments. This decision applies nationwide and has implications for the computation of some hospitals’ Medicaid DSH payments and for establishing hospitals’ [...]

joe2026-08-05T11:40:12-04:00August 6, 2026|340b, hospitals, Medicaid disproportionate share, Medicaid DSH|

Rural Areas Account for Net Loss of U.S. Hospitals

Rural hospitals are closing at a significant rate while the number of urban hospitals in the U.S. is mostly holding steady, according to a new analysis. The Health Care Affordability Lab at Yale found that between 2001 and 2023, 114 new rural hospitals opened – but 348 closed, a net loss of 234 hospitals in rural areas. Thirty-one of the 50 states experienced a net loss of rural hospitals, led by Texas, (24), Tennessee (14), California and Georgia (12), and Kansas (10). States with the biggest net increases in rural hospitals were Wyoming (5), Colorado (3), and Nevada (3). Meanwhile, [...]

joe2026-08-04T17:49:32-04:00August 5, 2026|hospitals|

AHRQ Pulls Back Research Funding

Many groups that were awarded multi-year grants by the Agency for Healthcare Research and Quality are now being informed that they will not be receiving the additional funding they were told they could expect. In letters it is sending to such organizations, AHRQ is informing them it is not providing additional funding because its priorities have changed. Specifically, the letters explain that AHRQ's current priorities include focusing agency resources on patient safety, preventing antibiotic resistance, telehealth, overmedication of children, use of digital health tools to improve health, long COVID, artificial intelligence, nutrition, furthering understanding of autism, promoting research focused on [...]

joe2026-07-30T16:58:58-04:00August 3, 2026|Uncategorized|

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