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Federal Health Policy Update for October 15

Don’t Miss: IRS proposes changes in rules governing ACA premium tax credits Lawsuit and legislation aim to block 340B Rebate Model Program CMS updates telehealth FAQ The following is the latest health policy news from the federal government for October 9-15. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will reconvene after the mid-term elections on November 9. Upon their return, one of their priorities will be advancing a government funding package because the current continuing resolution (CR) expires on December [...]

October 15, 2026|Categories: 340b, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|Tags: 340B, 3430B Rebate Model Program, Affordable Care Act premium tax credits, CMS authority to exclude, CMS Medicare telehealth FAQ, FDA Rare Disease Framework Initiative, IDR Gateway, independent dispute resolution, Maternal Produce Prescription Program, Medicaid state plan amendments, Medicare clinician quality initiatives, Medicare FY 2027 inpatient psychiatric facilities prospective payment system, Medicare home health prospective payment system, Medicare Payment Advisory Commission, Medicare physician fee schedule, Medicare skilled nursing facility payment system, MedPAC, MLN Connects, Newborn Essentials Support Kit NEST, No Surprises Act, organ procurement and transplantation network, proposed IRS rule on Affordable Care Act premium tax credits, Rural Health Transformation Program grants|

The Curious Case of Improper Medicaid Payments

While the Centers for Medicare & Medicaid Services continues its efforts to “crush” Medicaid fraud, a new report says that the biggest source of improper Medicaid payments is… Flawed paperwork. While improper payments generally are categorized as fraud, waste, and abuse, CMS’s focus has been squarely on fraud. At the same time, however, the Congressional Research Service recently reported that flawed paperwork, and not necessarily an attempt to inappropriately or illegally profit from Medicaid payments, is most of the problem. According to the report, CMS estimates that most improper payments [...]

October 15, 2026|Categories: Medicaid|Tags: Medicaid fraud, Medicaid improper paperwork, Medicaid waste fraud and abuse|

MedPAC Meets

Members of the Medicare Payment Advisory Commission held their latest public meeting on Thursday, October 8 and Friday, October 9. The subjects on the meeting’s agenda were: Issues affecting the payment accuracy of the physician fee schedule and the clinical laboratory fee schedule Clinician quality initiatives in fee-for-service Medicare Medicare’s late-enrollment penalties Workplan: assessing the accuracy of the skilled nursing facility and home health prospective payment systems Go here for a summary of each of these issues, key points, future action items, and links to MedPAC staff presentations. MedPAC is [...]

October 14, 2026|Categories: Medicare, MedPAC|Tags: Medicare, Medicare clinical laboratory fee schedule, Medicare home health prospective payment system, Medicare late enrollment penalty, Medicare Payment Advisory Commission, Medicare physician fee schedule, Medicare skilled nursing facility prospective payment system, MedPAC|

Federal Health Policy Update for October 8

Don’t Miss: Latest 340B developments CMS penalizes majority of hospitals for failing to meet Readmissions Reduction Program standards FTC reminds hospitals of price transparency requirements The following is the latest health policy news from the federal government for October 2-8. Some of the language used below is taken directly from government documents. The White House The White House announced that the federal government will make one-time payments of $90 per person to more than 20 million Medicare enrollees – about one-third of Medicare participants – to help them pay their [...]

October 8, 2026|Categories: 340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|Tags: 340B, 340B and Medicare, 340B Rebate Model Pilot Program, APMs, CDC Morbidity and Mortality Weekly Report, Certified Community Behavioral Health Clinics, CJR-X Model, Clinical Laboratory Improvement Amendments CLIA, Comprehensive Joint Replacement Expanded Model, DMEPOS, F-1 visas, FTC and hospital price transparency, Globe Benchmark for Efficient Drug Pricing Model, GLOBE Model, HRSA National Survey of Children’s Health, Independent Dispute Resolution process, Medicaid, Medicaid state plan amendments, Medicaid state waiver approvals, Medicare, Medicare Alternative Payment Models APMs, Medicare area wage index, Medicare disproportionate share, Medicare DSH, Medicare durable medical equipment prosthetics orthotics and supplies, Medicare FY 2027 inpatient prospective payment system rule, Medicare FY 2027 long-term care hospital prospective payment system rule, Medicare Health Outcomes Survey, Medicare hospital outpatient prospective payment system rule, Medicare hospital readmissions reduction program, Medicare outlier payments, MLN Connects, Office of the National Coordinator for Health Information Technology (ONC), Remote patient monitoring programs, Rural Health Transformation Program funding, Transformed-Medicaid Statistical Information System T-MSIS, transparency in coverage rule|

Federal Health Policy Update for October 1

Don’t Miss: CMS partners with 37 states to launch Medicaid quality initiative CMS fleshes out GLOBE Model Medicare Part D Claims Data 340B Repository goes live The following is the latest health policy news from the federal government for September 25 - October 1. Some of the language used below is taken directly from government documents. The White House A statement issued by the White House titled “President Trump Takes Historic Action to Eliminate Wasteful and Harmful Spending” includes a series of cuts, or rescissions, of health-related federal expenditures, including [...]

October 1, 2026|Categories: 340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|Tags: 340B, 340B Data Repository, America.gov, Basic Health Program, CJR Expanded Model, CJR-X Model, CMS and states quality initiative, CMS and states quality program, CMS GLOBE Model, CMS risk-based nursing home survey, Comprehensive Care for Joint Replacement model, Living Organ Donation Reimbursement Program, MACPAC, MACPAC inpatient hospital payment index, Medicaid 1115 waivers, Medicaid and CHIP Payment and Access Commission, Medicaid community engagement requirement, Medicaid home and community based services, Medicaid Quality Pledge, Medicaid state directed payments, Medicaid state plan amendments, Medicare Advantage, NIH Linked Discoveries program, Real-time Platform Adaptive Seamless Trials program, Review Choice Demonstration for Inpatient Rehabilitation Facility Services program, Rural Communities Opioid Response Program, Rural Health Transformation Program, Simulation-augmented, SURPASS program, Treasury Department Do Not Pay Working System|

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