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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 [...]

Federal Health Policy Update for August 14

The following is the latest health policy news from the federal government for August 8-14. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess and will return to Washington D.C. on September 2. Funding for the federal government, along with health care extenders including extensions of 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, all expire September 30. In the fall, [...]

August 14, 2025|Categories: Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare post-acute care, Medicare reimbursement policy, Telehealth|Tags: 340B, Acute Hospital at Home Program, health care data interoperability, Health Resources and Services Administration, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid financing, Medicaid state directed payments, Medicaid state plan amendments, Medicare Advantage, Medicare dependent hospital program, Medicare long-term-care hospital payments, Medicare low-volume hospital program, Medicare site-neutral payment policy, MLN Connects, Pediatric Specialty Loan Repayment Program, Substance Use Disorder Treatment an Recovery Loan Repayment Program, telehealth|

Potential Medicaid Implications of the “One Big Beautiful Act”

Growing uncompensated care. Service cuts. Reduced access to care, especially in rural areas. Expansion projects placed on hold. These are among the potential implications of the Medicaid cuts included in the recently passed FY 2025 budget reconciliation bill, often referred to as the “One Big Beautiful Act.” A significant portion of those cuts will come through limits on state directed payments: supplemental Medicaid payments proposed by the states and approved by the federal government to selected providers for high-cost, high-demand, low-payment services delivered through Medicaid managed care plans. The new [...]

August 13, 2025|Categories: hospitals, Medicaid, Medicaid managed care|Tags: FY 2025 budget reconciliation bill, Hospital uncompensated care, Medicaid cuts, Medicaid state directed payments, state directed payments|

Coming Soon: The Rural Health Transformation Program

Federal health care officials are getting ready to bring the FY 2025 budget reconciliation bill’s “Rural Health Transformation Program” to life. Added to the “One Big Beautiful Bill” to provide assistance to rural hospitals that maintained that their existence would be jeopardized by the Medicaid cuts and other health care changes in the law, the Rural Health Transformation Fund will consist of $50 billion to be distributed to rural health care organizations over a five-year period. Half of that money will go to states that successfully apply it – the [...]

August 11, 2025|Categories: hospitals, Medicaid|Tags: Rural Health Transformation Program|

Federal Health Policy Update for August 7

The following is the latest health policy news from the federal government for August 2-7. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess. When Congress returns in September its top priority will be funding the federal government before the fiscal year ends on September 30, likely requiring a continuing resolution to avoid a shutdown. Several major health care programs and extenders are set to expire at the end of the fiscal year, including Medicaid disproportionate share (Medicaid [...]

August 7, 2025|Categories: 340b, Congress, COVID-19, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy, Telehealth|Tags: 340B, 340B Rebate Model Pilot Program, Acute Hospital Care at Home, approved Medicaid state plan amendments, CDC and opioid labeling requirements, CDC and opioid prescribing directions, Connecting Kids to Coverage Outreach and Enrollment Cooperative Agreement, FY 2026 Medicare hospice rates, FY 2026 Medicare inpatient prospective payment system and long-term care hospital prospective payment system, FY 2026 Medicare inpatient psychiatric facility prospective payment system, FY 2026 Medicare inpatient psychiatric facility rates, FY 2026 Medicare inpatient rates, FY 2026 Medicare inpatient rehabilitation facility prospective payment system, FY 2026 Medicare inpatient rehabilitation facility rates, FY 2026 Medicare long-term hospital rates, FY 2026 Medicare skilled nursing facility prospective payment system, FY 2026 Medicare skilled nursing facility rates, GAO COVID-19 report, Justice Department DEI memo, Justice Department memo on unlawful discrimination, Medicaid disproportionate share, Medicaid DSH, Medicare Payment Advisory Commission, Medicare site-neutral payments for hospitals, MedPAC, MLN Connects, mRNA vaccines, new MedPAC commissioners, Pharmaceutical companies most favored nation prices, rescinded COVID-19 waivers, telehealth|

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