joe, Author at DeBrunner & Associates

Federal Health Policy Update for June 4

Don’t miss: CMS publishes new Medicaid work/community engagement requirements Energy and Commerce Committee looks at price transparency in health care An AI executive order and Congress prepares to weigh in Price cut: IDR dispute fee to fall from $115 to $15 per dispute The following is the latest health policy news from the federal government for May 29 to June 4. Some of the language used below is taken directly from government documents. Medicaid Work Requirements – Interim Final Rule CMS has published an interim final rule with comment period to implement the Medicaid work and community engagement requirements [...]

joe2026-06-04T16:30:46-04:00June 4, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare|

A 340B Scorecard

Hospitals suing CVS Health over 340B savings. The Health Resources and Services Administration’s proposed 340B Rebate Model Pilot Program. Eli Lilly’s demand that hospitals share claims-level data for 340B-covered drugs. The continuing battle over the involvement of contract pharmacies in providing access to 340B-covered drugs. Sometimes it seems as if barely a week passes without some new challenge to the 340B program. In a recent article, Becker’s Hospital News presents an update on the latest in challenges to the 340B program. Learn more from its article “340B in 2026: Tracking litigation, mandates and policy shifts reshaping the program.”

joe2026-06-03T12:31:11-04:00June 4, 2026|340b|

CMS Proposes New Medicaid Eligibility Requirements

The Centers for Medicare & Medicaid Services has published an interim final rule implementing the Medicaid work/community engagement requirements mandated by H.R. 1, last year’s federal budget reconciliation bill. The rule defines community engagement requirements for adults to gain or maintain Medicaid eligibility for applications on or after January 1, 2027. Under the rule, individuals will be eligible for Medicaid if they participate in 80 hours of employment, community service, work programs, or other qualifying activities. Under this interim final rule, states must: identify who is subject to or exempt from the work requirements verify compliance at application and renewal [...]

joe2026-06-03T08:06:29-04:00June 3, 2026|Medicaid|

HHS Advisory Committee Holds First Meeting

An advisory panel created by the Department of Health and Human Services to advise the agency on how to improve the financing and delivery of health care by Medicare, Medicaid, and the Children’s Health Insurance Program and through the health insurance marketplace held its first public meeting earlier this week. HHS’s Healthcare Advisory Committee, which consists of 15 members, discussed its bylaws and heard presentations from the leaders of its six workgroups. Those workgroups are: Reducing Administrative Burden MAHA by Improving Wellness and Preventing Chronic Disease Deploying Real-Time Data Improving Care for Vulnerable Populations Strengthening Medicare Advantage Crushing Fraud, Waste, [...]

joe2026-05-20T09:26:01-04:00May 22, 2026|Medicaid, Medicare|

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|

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