joe, Author at DeBrunner & Associates

Federal Health Policy Update for October 1

Don’t Miss: CMS partners with 37 states to launch Medicaid quality initiative CMS fleshes out GLOBE Model Medicare Part D Claims Data 340B Repository goes live The following is the latest health policy news from the federal government for September 25 - October 1. Some of the language used below is taken directly from government documents. The White House A statement issued by the White House titled “President Trump Takes Historic Action to Eliminate Wasteful and Harmful Spending” includes a series of cuts, or rescissions, of health-related federal expenditures, including $567 million for taxpayer-funded HHS services for non-citizens; $28 million [...]

joe2026-10-01T17:04:13-04:00October 1, 2026|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and homelessness, Medicaid regulations, Medicare, 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 meeting: MACPAC’s September 2026 meeting began with a discussion around community engagement (CE) requirements in Medicaid. The 2025 Budget Reconciliation Act established CE requirements and delegates to the Secretary the authority to set certain standards and procedures that the Centers for Medicare & Medicaid Services (CMS) addressed in the interim final rule with comment (IFC), issued on June 1, 2026. Staff summarized key IFC provisions, including individuals subject to CE, exceptions and exclusions from CE, state [...]

joe2026-09-30T11:58:20-04:00October 1, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid regulations|

Imminent Changes in Medicaid Eligibility for Immigrants

Come October 1, immigrants seeking Medicaid benefits – including lawful immigrants – will face a new array of eligibility criteria and requirements. KFF has presented a broad look at those new criteria, ushered in as a result of last year’s federal budget reconciliation bill – also known as H.R. 1 and the One Big Beautiful Act Bill – and how they are expected to be implemented. The major aspects of the coming changes are (all quoted directly from the KFF review): States must redetermine eligibility for all “potentially affected” existing Medicaid enrollees under the new rules by October 1, 2026, [...]

joe2026-09-30T08:25:08-04:00September 30, 2026|Medicaid|

Federal Health Policy Update for September 24

Don’t Miss: CMS plans major cuts in Medicare clinical lab payments Administration reconsiders shifting NIH grant decisions to White House All states enroll in CMS model to reduce prices of selected Medicaid-covered drugs The following is the latest health policy news from the federal government for September 18-24. Some of the language used below is taken directly from government documents. The White House The White House has issued the executive order “Enhancing Program Integrity and Interagency Coordination in the Administration of the H-1B Nonimmigrant Visa Program.” The order increases federal oversight of the H-1B visa program because “The abuse of [...]

joe2026-09-24T15:28:11-04:00September 24, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|

Where Have All the Nursing Home Beds Gone?

Across the country, the supply of nursing homes is dwindling. Nationally, the Centers for Medicare & Medicaid Services reports 900 fewer certified nursing homes in 2025 than in 2015. Why the decline? The most commonly cited reason is inadequate payments from Medicaid, the leading payer for nursing home care, which generally pays less than the daily cost of care. Another is staffing: nursing home jobs pay poorly and are considered stressful, making it difficult to attract and retain staff. Even the erosion in the number of beds may not completely capture the decline in access to skilled nursing care. More [...]

joe2026-09-24T08:44:20-04:00September 24, 2026|Uncategorized|

CMS Eyes Major Cuts in Medicare Clinical Lab Rates

Medicare payments for clinical laboratory services will soon be coming down. The Centers for Medicare & Medicaid Services is working to bring Medicare’s clinical laboratory services rates into line with those paid by commercial insurers. Asserting that Medicare is now paying 16 percent more for clinical lab tests than commercial payers, the agency has posted proposed rates for calendar year 2027 that reflect the beginning of what in some cases will be a multi-year process of aligning public and private lab payments – “aligning” by reducing Medicare payments. Hospital laboratories perform between 40 and 55 percent of laboratory tests. While [...]

joe2026-09-22T17:17:48-04:00September 23, 2026|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare reimbursement policy|

Immigrant Families Skipping Health Care for Kids

Immigrant families with children appear to be avoiding seeking health care over concern about their immigration status, according to a new survey of pediatricians. The survey, conducted on behalf of the American Academy of Pediatrics, found that: Forty percent of pediatricians reported that immigrant families with children are avoiding seeking care for their children because of concern about their immigration status. Thirty-one percent said those same families were avoiding applying for any government programs, including Medicaid, the Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program (SNAP). More than 20 percent said they served immigrant families that were [...]

joe2026-09-17T15:36:28-04:00September 21, 2026|Medicaid|

Federal Health Policy Update for September 17

Don’t Miss: CMS advises on “medical frailty” as qualification for Medicaid eligibility CMS unveils long-anticipated IDR Gateway Medicare ACCESS Model to expand The following is the latest health policy news from the federal government for September 11-17. Some of the language used below is taken directly from government documents. Congress The House Energy & Commerce Committee’s Health Subcommittee held a hearing to discuss bills seeking to modify certain physician payments under Medicare, to address cybersecurity in the health care system, and to expand seniors’ access to care. See the chairman’s opening statement here and find a list of witnesses [...]

joe2026-09-17T16:23:30-04:00September 17, 2026|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Hospitals Continue to Struggle with Price Transparency

Since the beginning of 2021, hospitals have been required to make their prices transparent to the public. Five years later, roughly half of them do – more than at any point since the requirement took effect. But that also means that roughly half of them still do not. Under the law, hospitals are required to make their prices public via machine-readable files that show standard charges, gross prices, negotiated rates with specific payers, discounted cash prices, and prices for the 300 most commonly provided hospital services. Progress toward achieving this objective, however, has been slow: compliance estimated at 5.6 percent [...]

joe2026-09-16T16:23:32-04:00September 17, 2026|hospitals|

CMS Fleshes Out “Medical Frailty” Criterion for Medicaid Eligibility

When Congress included major reductions in Medicaid eligibility in last year’s budget reconciliation bill – H.R. 1, often referred to as the “One Big Beautiful Bill Act” – it included one criterion for Medicaid eligibility that immediately proved challenging. While the new law requires individuals to work or participate in “community engagement” activities such as attending school or performing volunteer work” as a condition of Medicaid eligibility, it offered an exception to this requirement: those found to be “medically frail.” The law, however, did little to define what constitutes medical frailty beyond defining as medically frail those who are blind [...]

joe2026-09-15T16:39:05-04:00September 16, 2026|Medicaid|

joe

About joe