joe, Author at DeBrunner & Associates

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|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. During the course of the deliberations, MACPAC’s staff made the following presentations to the commissioners: Automation in Medicaid Prior Authorization: Recommendations Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care for the Elderly: Recommendations and Updated Implications Appropriate Access to Residential Services for Children and Youth with Behavioral Health Needs: Recommendations Implementing Community Engagement Requirements in Medicaid: Recommendation and Updated Implications Children and Youth with Special Health Care Needs Transitions to Adult Coverage: Recommendations and Updated Implications Click the [...]

joe2026-05-12T14:55:54-04:00May 13, 2026|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and housing, Medicaid and housing for the disabled, Medicaid regulations for the disabled|

Hospital at Home Proving its Worth?

A new study suggests that hospital at home programs are producing positive results for patients and the health care system. Positive results such as greater comfort for patients, fewer returns to the hospital emergency department within 30 days of discharge, lower in-hospital mortality, reduced costs, and improved outcomes. Serving patients at home also frees hospital beds for sicker patients – an important consideration in communities where hospital occupancy levels are especially high. In hospital at home programs, patients receive acute-care services in their own homes with the help of remote monitoring and home visits by clinicians. One downside so far: [...]

joe2026-05-07T16:56:22-04:00May 12, 2026|hospitals, Medicare, Uncategorized|

The Latest CMS Efforts on Prior Authorization

The Centers for Medicare & Medicaid Services continues to work tackling the challenges posed by health insurers that insist they will not pay for certain medical services unless they authorize those services beforehand. In a new blog post, CMS Administrator Mehmet Oz reviews past, current, and future agency efforts to address the challenges posed by the need to obtain prior authorization for medical services. The latest such step, he notes, is adding electronic prior authorization to the Health Tech Ecosystem. Under this approach, work groups across the spectrum of stakeholders seek to align CMS Interoperability and Prior Authorization Final Rule [...]

joe2026-05-07T14:16:35-04:00May 11, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare|

Federal Health Policy Update for May 7

The following is the latest health policy news from the federal government for May 1-7. Some of the language used below is taken directly from government documents. Congress Congress hopes to pass a reconciliation package to fund Immigration and Customs Enforcement (ICE) and Customs and Border Protection before June 1; lawmakers would then turn to a potential third reconciliation measure to address health care affordability before the mid-term elections. Health care provisions in a potential third reconciliation bill could include expanded access to health savings accounts (HSAs); changes to the rate at which the federal government matches state Medicaid spending [...]

joe2026-05-07T16:06:32-04:00May 7, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

HHS to Attack Overprescribing of Psychiatric Drugs

The Department of Health and Human Services is launching a campaign to reduce the frequency with which providers prescribe drugs for patients with behavioral health challenges. The new campaign, announced earlier this week, will seek to analyze prescribing patterns for psychiatric drugs, evaluate those that are and are not effective, and advocate greater use of alternative, non-medication-based treatments. To support this effort, HHS plans to develop new policies and promote and support more education and outreach. HHS also has issued two sets guidelines, developed by its Substance Abuse and Mental Health Services Administration (SAMHSA): one is a “dear colleague” letter [...]

joe2026-05-05T17:04:55-04:00May 7, 2026|Uncategorized|

States Continue to Work on Medicaid Eligibility Changes

With last year’s budget reconciliation bill – also known as H.R. 1 and the “Big Beautiful Bill Act” – requiring most Medicaid beneficiaries to have jobs or participate in community engagement activities beginning next year, the states continue to develop and refine the policies and practices they will need to implement and enforce the new requirements. The KFF has surveyed state Medicaid officials to identify what the states are doing and how they are doing it. Among Kaiser’s findings: Three states intend to implement the new Medicaid work requirements this year – ahead of the January 2027 implementation deadline – [...]

joe2026-05-05T15:41:31-04:00May 6, 2026|Medicaid|

Federal Health Policy Update for April 30

The following is the latest health policy news from the federal government for April 24-30. Some of the language used below is taken directly from government documents. Congress Yesterday, House Republicans adopted the Senate’s budget resolution, clearing the way for the party-line reconciliation process to move into the drafting phase. The limited budget resolution for Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection instructs the Senate Judiciary and Homeland Security committees to write legislation by May 15. Today, the House passed the Senate’s spending bill to fund the rest of the Department of Homeland Security, including FEMA. [...]

joe2026-04-30T14:21:14-04:00April 30, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Some States Seek to Expand Medicaid Work Requirements

While last year’s H.R. 1, often referred to as the “One Big Beautiful Act Bill,” introduced a requirement that Medicaid applicants document that they have worked, attended school, or participated in some form of community engagement for one month as a condition of eligibility for the program, a few states are looking to make that requirement more rigorous. Indiana, for example, has turned that one-month requirement into three months and Missouri, Arizona, and Kentucky are considering increasing the requirement as well. Missouri officials are even proposing a constitutional amendment that would ban the state from expanding the scope of current [...]

joe2026-04-29T10:33:23-04:00April 30, 2026|Medicaid|

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