The No Surprises Act’s Independent Dispute Resolution process continues during the federal government shutdown. The Centers for Medicare & Medicaid Services has issued a notice advising disputing parties to continue submitting disputes for resolutions but warns that a prolonged shutdown could affect the timeliness of the resolution of those disputes. Learn more from this CMS notice.
The following is the latest health policy news from the federal government for September 26 to October 3. Some of the language used below is taken directly from government documents. Health Care During the Government Shutdown With the federal government technically without spending authority now that FY 2026 has begun without an approved FY 2026 budget, the federal role in health care will change in some respects and be greatly reduced in others. Medicare and Medicaid will continue to function; previous legislation ensures Medicaid funding through the first quarter of FY 2026. States will continue to receive federal funding to [...]
With the federal government technically without spending authority now that FY 2026 has begun without an approved FY 2026 budget, the federal role in health care will change in some respects and be greatly reduced in others. The Department of Health and Human Services anticipates reducing its workforce by 40 percent during the federal government shutdown while the Centers for Medicare & Medicaid Services anticipates furloughing nearly half its staff. The Office of Management and Budget has issued a memo encouraging agencies to consider making at least some and possibly many of these furloughs permanent. Medicare and Medicaid will continue [...]
The Medicaid work/community engagement requirement included in the “One Big Beautiful Bill” Act could cost hospitals millions of dollars – losses that could translate into potential declines of 11.7-13.3 percent in hospital operating margins, according to a Commonwealth Fund analysis based on Urban Institute data. Not all current Medicaid participants are subject to the new work and community engagement requirements but between 5.5 million and 6.3 million people are expected to lose their Medicaid benefits as a result of those requirements. Among them, some will be newly unemployed; some will be unable to find work; and some will be employed [...]
Hospital readmissions penalties will increase, as will the size of the typical penalty, in the coming year. Beginning in FY 2026, the proportion of hospitals that will be penalized at least one percent for excessive readmissions under the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program will rise from seven percent of all hospitals to eight percent. The number of hospitals penalized less than one percent will decline. Hospitals that care for the highest proportions of dually eligible Medicare/Medicaid patients will see their penalties increase slightly. The penalties levied in FY 2026 will reflect hospital performance between July [...]
Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. The following is MACPAC’s own summary of its two days of public meetings. MACPAC’s September 2025 meeting began with a summary of Public Law 119-21, an Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 (2025 Budget Reconciliation Act, P.L. 119-21). This legislation included several provisions affecting Medicaid and the State Children’s Health Insurance Program (CHIP). In this session, staff provided a summary of the Medicaid and CHIP-related provisions in the 2025 Budget Reconciliation Act. Staff then presented on work [...]
The following is the latest health policy news from the federal government for September 19-25. Some of the language used below is taken directly from government documents. Federal Funding for Fiscal Year 2026 Telehealth and Acute Hospital Care at Home Program Flexibilities Many current telehealth flexibilities and authorization for the Acute Hospital Care at Home program will expire on September 30 unless Congress extends them. The following is CMS’s current guidance on these programs if they are not extended by September 30: The CMS Acute Hospital Care at Home web page advises stakeholders that The Acute Hospital Care at Home [...]
Changes adopted in the FY 2026 budget reconciliation bill (“the One Big Beautiful Bill” Act) could result in a significant increase in the ranks of the uninsured across the country. According to an Urban Institute analysis supported by the Commonwealth Fund, if current expanded health insurance premium tax credits end with the beginning of the new federal fiscal year on October 1, 4.8 million more people would become uninsured, a 21 percent increase. 3 million fewer people across the U.S. would get subsidized marketplace coverage. Premiums would soar. For people earning less than 250 percent of poverty (about $39,000 for [...]
The following is the latest health policy news from the federal government for September 12-18. Some of the language used below is taken directly from government documents. Congress Funding for the federal government expires on September 30. Members of Congress have not yet coalesced around a plan to fund the federal government when the new federal fiscal year begins on October 1, with House Republican and Democratic leaders releasing competing legislative texts for a short-term continuing resolution (CR). House Republicans have proposed a CR to last through November 21 with very few anomalies, or policy changes, outside of regular spending. [...]
Health care providers are expressing concern about two new programs recently announced by the Department of Health and Human Services: the Centers for Medicare & Medicaid Services’ Medicare WISeR (Wasteful and Inappropriate Service Reduction) Model and HHS’s 340B Rebate Model Pilot Program. The WISeR model, to be tested in six states, will require doctors to obtain prior authorization before providing a limited group of services. That prior authorization is expected to be delivered primarily through the use of AI. Participation will be mandatory in the states involved in the program and providers are concerned that it will increase their administrative [...]