Bulletin Board

Federal Health Policy Update for August 21

The following is the latest health policy news from the federal government for August 15-21. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess and will return to Washington D.C. on September 2. Funding for the federal government expires on September 30, as will a number of health care extenders, including for telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments. In the [...]

August 21, 2025|Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare reimbursement policy, post-acute care, Telehealth|Tags: Acute Hospital Care at Home program, critical access hospitals, Federal FY 2025 budget, Federal Healthcare Advisory Committee, FY 2025 budget reconciliation law, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid eligibility, Medicaid HCBS, Medicaid home and community based services, Medicaid state directed payments, Medicaid state plan amendments, Medicare Advantage, Medicare and GME, Medicare and graduate medical education, Medicare dependent hospital program, Medicare long-term-care hospital payments, Medicare low-volume hospital program, Medicare sequestration, Medicare site-neutral payments, MLN Connects, OSHA COVID-19 requirements, PAYGO, telehealth, Wasteful and Inappropriate Service Reduction Model, WISeR Model|

Potential Implications of the One Big Beautiful Bill Act

The publication Health Affairs has published a number of newsletters and articles about the so-called One Big Beautiful Bill and its potential implications for consumers and providers. To learn more, see the following pieces: “The BBB: Consumer Choice and Market Competition” “The Budget Bill’s Impact on Immigrant Access to Health Care” “The 'One Big Beautiful Bill,' Now Law, Does Not Protect Rural Hospitals” “With Budget Reconciliation Bill Enacted, Health Care Changes Loom” “The Big Beautiful Bill: A New Era for Health Policy? w/ Katie Keith” “Trump's Deregulation Era & The [...]

August 21, 2025|Categories: Congress, hospitals|Tags: One Big Beautiful Bill, One Big Beautiful Bill and consumer choice, One Big Beautiful Bill and deregulation, One Big Beautiful Bill and health policy, One Big Beautiful Bill and immigrant access to health care, One Big Beautiful Bill and market competition, One Big Beautiful Bill and rural hospitals|

Putting Some Meat on CMS’s WISeR Bones

In June, the Centers for Medicare & Medicaid Services announced a new CMS Innovation Center model: The Wasteful and Inappropriate Service Reduction Model, or WISeR. The idea behind WISeR is for Medicare to seek to reduce waste, fraud, and abuse in the program by working through technology companies to make greater use of prior authorization and pre-payment reviews for a small group of medical items and services that the agency considers susceptible to misuse or unnecessary use. While the program is scheduled to start next January 1 and CMS has [...]

August 20, 2025|Categories: Center for Medicare and Medicaid Innovation, CMMI, Medicare, Medicare reimbursement policy|Tags: CMS Innovation Center, Medicare, Wasteful and Inappropriate Service Reduction Model, WISeR Model|

The Likelihood of Major Medicare Cuts

While the potential for significant Medicaid cuts resulting from passage of the FY 2025 federal budget reconciliation bill – the so-called One Big Beautiful Bill – has received a great detail of attention, the possibility of Medicare cuts as well has flown mostly under the radar. Until now. In a letter to Democratic congressional committee leaders, the Congressional Budget Office has put a price tag on prospective Medicare cuts. According to the CBO, the FY 2025 budget reconciliation bill could lead to more than $500 billion in federal Medicare payment [...]

August 20, 2025|Categories: Medicaid, Medicare, Medicare reimbursement policy|Tags: Congressional Budget Office, FY 2025 budget reconciliation bill, Medicaid cuts, Medicare cuts, Medicare sequestration, One Big Beautiful Bill, PAYGO cuts|

Survey Looks at Prior Authorization in Medicaid

A recently published study takes a closer look at the state of prior authorization practices in state Medicaid managed care programs. The survey explored prior authorization decision time frames, the use of electronic denial notices, patient access to external medical review, and processes and time frames for prior authorization decisions and appeals based on federal Medicaid managed care rules. Among the survey’s findings: “Nearly half of responding states (17 of 36) reported requiring standard prior authorization decisions within 7 calendar days (18 states) or a shorter timeframe (9 states). “About [...]

August 18, 2025|Categories: Medicaid, Medicaid managed care|Tags: Medicaid managed care, Medicaid managed care prior authorization, Medicaid managed care survey|

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