joe, Author at DeBrunner & Associates

Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold a hearing titled “State Medicaid Program Integrity: Examining Fraud Risks [...]

joe2026-06-18T16:07:51-04:00June 18, 2026|340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Making Sense of New Medicaid Medical Frailty Exemption

The recent release of new Medicaid work and community engagement requirements has raised nearly as many questions as it answers about who will and who will not be eligible for Medicaid when the new criteria take effect next year. While the work and community engagement requirements themselves are relatively straightforward, questions remain about the medical frailty exception and who, based on their medical condition, will be exempt from the work or community engagement requirement. A number of sources have reported on the medical frailty exception. NY Times – “Trump Administration Announces Stricter Rules for Medicaid Work Requirement” Health Affairs – [...]

joe2026-06-17T12:21:01-04:00June 18, 2026|Medicaid|

MACPAC Issues Report to Congress

The Medicaid and CHIP Payment and Access Commission has sent its 2026 report to Congress. The report – mandated by Congress – includes recommendations for: overseeing community engagement/work requirements in Medicaid, including MedPAC’s recommendation that the Centers for Medicare & Medicaid Services develop a transparent plan through which it can monitor and evaluate community engagement requirements improving CMS’s oversight of the use of automation in Medicaid prior authorization decisions improving the accountability of states’ Medicaid managed care programs appropriate access to residential treatment services for Medicaid-enrolled youth with special behavioral health needs and disabilities facilitating the transition of children and [...]

joe2026-06-17T09:45:11-04:00June 17, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care|

MedPAC Reports to Congress

The Medicare Payment Advisory Commission has issued its annual report to Congress. This year’s report examines: how Medicare payment incentives affect federal spending and the delivery of care and how those incentives can be improved the challenges beneficiaries encounter when deciding on their enrollment in Medicare how Medicare identifies improper payments – and how it can do so more effectively the association between enrollment in Medicare Advantage plans and provider finances access to selected palliative care services under Medicare’s hospice benefit MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding [...]

joe2026-06-16T16:58:28-04:00June 17, 2026|hospitals, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for June 11

The following is the latest health policy news from the federal government for June 5-11. Some of the language used below is taken directly from government documents. Don’t Miss: CMS warns more than 500 hospitals for failing to meet price transparency requirements HHS OIG looks at Medicare Advantage rejections of post-acute services Federal court rejects $100,000 H-1B visa fee HHS RFI seeks new approaches, including AI, for treating addiction CMS creates new office to help with tech modernization Congress Some Republican members of Congress continue to plan for a third party-line reconciliation bill to focus on health care affordability. The [...]

joe2026-06-11T16:08:27-04:00June 11, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Marketplace Enrollment Declines

With the elimination of enhanced premium tax credits, enrollment in Affordable Care Act health insurance exchange plans is falling. Last year saw 24 million people enroll in ACA marketplace plans – an all-time high. 2026 enrollment, though, is down 1.2 million, or five percent – the largest year-to-year decline since the exchanges started offering health insurance in 2014. Overall, enrollment has fallen in 41 states, with those declines ranging from one to 22 percent. In addition, 14 percent of those who signed up for plans in 2026, or who were automatically reenrolled because of past enrollment, did not pay their [...]

joe2026-06-10T11:43:01-04:00June 11, 2026|Affordable Care Act|

CMS Warns Hospitals About Price Transparency

The Centers for Medicare & Medicaid Services has written to more than 500 hospitals, warning them that they are failing to meet federal requirements for price transparency. The letter warns hospitals that they are at risk of fines if they do not publicly provide more and better price information. Some have been told they must submit improvement plans. CMS’s view is that the lack of price transparency prevents consumers from comparing hospitals’ prices for services. Learn more about the CMS warning and find a link to a list of the hospitals that have been warned in the AP article “Trump [...]

joe2026-06-09T17:20:07-04:00June 10, 2026|Centers for Medicare & Medicaid Services, hospitals|

CMS Defines “Medical Frailty” for Medicaid Eligibility Purposes

With the federal government about to implement a work/community engagement requirement for eligibility for Medicaid coverage, regulators have attempted to define what constitutes “medical frailty” as a reason for exemption from that requirement. In a new report, KFF explains that a newly adopted rule presenting the Medicaid work/community engagement requirement employs “… a restrictive definition of medical frailty that differs from states’ early expectations” and ties “… medical frailty specifically to the ability to comply with the community engagement requirement (i.e., the ability to work) and prohibiting states from adding categories of individuals to the medical frailty definition.” KFF also [...]

joe2026-06-04T17:20:17-04:00June 8, 2026|Medicaid|

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|

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