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Federal Health Policy Update for April 16

The following is the latest health policy news from the federal government for April 11-16. Some of the language used below is taken directly from government documents. CMS – New Proposed Regulations FY 2027 Medicare Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Proposed Rule CMS has published its proposed FY 2027 Medicare hospital inpatient and long-term-care hospital prospective payment system rule. The highlights of the proposed rule are: A 2.4 percent rate increase for both acute-care hospital inpatient and long-term care hospital services. A $564 [...]

April 16, 2026|Categories: Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|Tags: CDC advisory committee on immunization practices, CMS ACCESS Model, CMS interoperability standards and prior authorization for drugs proposed rule, House Ways and Means Committee, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid and community-based behavioral health services, Medicaid and home and community-based services, Medicaid and prior authorization, Medicaid certified Community Behavioral Health Clinics CCBHC), Medicaid community engagement requirements, Medicaid managed care, Medicaid work requirements, Medicare Advantage, Medicare Part D, Medicare Payment Advisory Commission, MedPAC, MLN Connects, Programs of All-Inclusive Care for the Elderly PACE, proposed Medicare FY 2027 hospital inpatient prospective payment system rule, proposed Medicare FY 2027 long-term care hospital prospective payment system proposed rule, Rural Health Transformation Program, state directed Medicaid payments, Ways and Means Committee hearing on health care affordability|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. During the course of the deliberations, MACPAC’s staff made the following presentations to the commissioners: Implementing Community Engagement Requirements in Medicaid State and Federal Tools for Ensuring Accountability of Medicaid Managed Care Plans: Draft Chapter Children and Youth with Special Health Care Needs (CYSHCN) Transitions to Adult Coverage: Draft Chapter and Recommendations Automation in the Prior Authorization Process: Draft Recommendations Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care [...]

April 16, 2026|Categories: MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care|Tags: MACPAC, Medicaid and assistive technology, Medicaid and CHIP Payment and Access Commission, Medicaid and community-based behavioral health services, Medicaid and home and community-based services, Medicaid and prior authorization, Medicaid and the Program of All-Inclusive Care, Medicaid community engagement requirements, Medicaid managed care, Medicaid program integrity|

MedPAC Meets

MedPAC’s commissioners held their latest public meeting on Thursday, April 9 and Friday, April 11. The subjects on the meeting’s agenda were: improving payment incentives in Medicare analysis of regional benchmarks and benchmark-plan availability in the Part D prescription drug plan market preferred networks and pharmacy access in Part D estimated association between Medicare Advantage enrollment and hospitals’ and post-acute care providers’ finances information sources that beneficiaries use to make Medicare enrollment decisions institutional special-needs plans: provision of services, network-adequacy requirements, and star ratings mandated report: assessment of the Medicare [...]

April 15, 2026|Categories: Medicare regulations, Medicare reimbursement policy|Tags: Medicare Advantage, Medicare beneficiary enrollment decisions, Medicare ground ambulance data collection system, Medicare institutional special needs plans, Medicare Part D preferred networks and pharmacy access, Medicare Part D prescription drug plans, Medicare Payment Advisory Commission, Medicare payment incentives, MedPAC|

Is CON on the Way OUT in Rural States?

The federal Rural Health Transformation Program may sound the death knell for certificate-of-need laws in some states. The rural funding program, created last year as part of H.R. 1, often referred to as the One Big Beautiful Bill Act, is a five-year, $50 billion program intended to offset some of the damage anticipated as a result of that law’s 10-year reduction in federal health care spending, and especially its Medicaid cuts, on rural health care. While every state that applied for funding through the program was awarded grants, the Centers [...]

April 13, 2026|Categories: Centers for Medicare & Medicaid Services, Medicaid|Tags: certificate-of-need laws, Medicaid cuts, Rural Health Transformation Program|

Federal Health Policy Update for April 10

The following is the latest health policy news from the federal government for April 4-10. Some of the language used below is taken directly from government documents. Congress The House and Senate were in recess this week and are scheduled to be back in session on April 14. House Speaker Mike Johnson (R-LA) has indicated that the House will not vote on the Senate‑passed Department of Homeland Security continuing resolution until there is meaningful progress on a reconciliation package to fund U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs [...]

April 10, 2026|Categories: 340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|Tags: 340B, Alien Medicaid Eligibility law, hospital outpatient quality reporting program, hospital price transparency, House Ways and Means Committee affordability hearing, Medicaid eligibility, Medicaid eligibility redetermination, Medicaid state plan amendments, Medicare Advantage, Medicare Advantage and Part D Rate announcement, medicare advantage value-based insurance design model, Medicare Conditions of Participation self-attestation, Medicare site-neutral payments, MLN Connects, proposed FY 2027 Centers for Medicare & Medicaid Services budget, Rural Residency Planning and Development Program|

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