joe, Author at DeBrunner & Associates

Protecting Consumers AND Providers? No Surprise

As intended, the No Surprises Act is protecting consumers from unexpected medical bills. But it’s also protecting someone else: providers. In the three years since the No Surprises Act’s Independent Dispute Resolution process was implemented, providers have won about 85 percent of cases. In 2023 and 2024, that amounted to more than $2 billion in additional payments. One aspect of the No Surprises Act that has been a surprise is the frequency with which parties are resorting to it. Originally projected to settle about 17,000 disputes a year, the process has seen more than three million disputes filed during its [...]

joe2025-10-14T15:29:39-04:00October 15, 2025|Uncategorized|

Hospital Financial Progress in Jeopardy

While hospitals and health systems in general continue to move closer to their pre-pandemic level of financial performance, they now face challenges that threaten to undermine that progress. While they have slowly gotten their labor costs under control, providers now face rising non-labor costs, including for drugs and supplies. Meanwhile, two recent policies enacted by Congress may pose an even greater threat. New limits on Medicaid eligibility threaten to transform manageable losses from under-reimbursement for Medicaid services into uncompensated care at the same time that the elimination of enhanced Affordable Care Act insurance premium subsidies could turn lower-income working families [...]

joe2025-10-14T14:19:03-04:00October 15, 2025|Affordable Care Act, Congress, hospitals, Medicaid|

Misinterpretation of Shutdown Plagues Telehealth

When federal authorization for Medicare-covered telehealth services lapsed at the end of the federal fiscal year on September 30, it was only supposed to affect traditional Medicare participants. But not everyone got the message. Some providers, confused about the lapse of Medicare authorization, are refusing to prescribe telehealth services for their non-Medicare patients. In addition, some health insurers are declining to cover telehealth services for their non-Medicare patients, misinterpreting the scope of the loss of Medicare authorization for telehealth care – something they should not be doing, according to a health insurance industry trade group. Older patients, patients with limited [...]

joe2025-10-14T11:45:35-04:00October 14, 2025|Medicare, Telehealth|

Federal Health Policy Update for October 9

The following is the latest health policy news from the federal government for October 3-9. Some of the language used below is taken directly from government documents. Please note that most HHS and other health care-related agencies have indicated that they will not be announcing new policies, publishing proposed regulations, or updating their web sites during the current federal government shutdown. Congress and the Shutdown Today the Senate voted on separate Democratic- and Republican-led continuing resolutions (CRs) for the seventh time but again was unable to reach the 60-vote majority needed to pass a measure. Once again, only three Democratic senators [...]

joe2025-10-09T15:13:15-04:00October 9, 2025|Centers for Medicare & Medicaid Services, Congress, Medicaid, Medicaid managed care, Medicare|

States Looking to Medicaid For Spending Cuts?

Amid growing budget pressures, a number of states have reduced Medicaid payments to providers – and others are looking to Medicaid as a possible source of savings. So far, Idaho and North Carolina have reduced Medicaid payments to providers while Illinois is looking at Medicaid, among other sources, in the face of its governor’s desire to reduce spending by four percent in the coming year. In addition, Indiana is pursuing a complex process of increasing state Medicaid payments to some providers through state directed payments but the net effect, according to hospital groups, could be an actual reduction of nearly [...]

joe2025-10-08T11:42:46-04:00October 9, 2025|Medicaid|

States Mull Pursuit of Rural Health Transformation Money

Support to grow their health care workforce, including new or expanded medical education programs to attract doctors and nurses. Doing more to address chronic medical conditions. Better coordination of care and greater use of technology. Making greater use of telehealth. Improving the local transportation infrastructure as a means of improving access to care. These are among the ideas that health care officials from almost every state discussed recently at a networking workshop held last week by the Health Policy Futures Lab to discuss how states might approach crafting proposals seeking a portion of the first half of the $50 billion [...]

joe2025-10-07T15:50:11-04:00October 8, 2025|Medicaid, Telehealth|

Medicaid Work Rule May Hit Chronically Ill

The introduction of a work requirement for Medicaid eligibility may have the greatest impact on Medicaid beneficiaries with chronic illnesses. According to a new analysis of the approximately five million people who are likely to lose their Medicaid eligibility between now and 2034 because of the new work requirement introduced in the FY 2026 budget reconciliation bill (the “One Big Beautiful Act Bill,”) more than 85 percent have at least one chronic medical condition and more than 40 percent have at least three such conditions. The percentages rise, moreover, among current Medicaid beneficiaries over the age of 50. Some of [...]

joe2025-10-07T13:44:24-04:00October 8, 2025|Medicaid|

Dispute Resolution Continues Despite Shutdown

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.

joe2025-10-07T11:52:54-04:00October 7, 2025|Centers for Medicare & Medicaid Services|

Federal Health Policy Update for October 3

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 [...]

joe2025-10-03T14:33:33-04:00October 3, 2025|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicare, Medicare reimbursement policy, Telehealth|

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. 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 [...]

joe2025-10-01T08:42:28-04:00October 1, 2025|Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Telehealth|

joe

About joe