Bulletin Board
Bulletin Board
Prior Authorization Remains a Challenge
Getting timely prior authorization for needed medical care continues to pose a problem for patients and providers. Despite federal government action to address prior authorization concerns associated with health care programs it oversees – Medicare Advantage, Medicaid and CHIP fee-for-service and managed care plans, and Affordable Care Act Marketplace plans – and the insistence of some insurers that they have been addressing the issue, problems persist. According to a recent analysis by KFF (quoted directly): Medicare Advantage insurers denied 12% of standard prior authorization requests, Medicaid managed care insurers denied [...]
MedPAC Looks to the Year Ahead
In anticipation of the start of its 2026-2027 public meeting cycle next month, the Medicare Payment Advisory Commission has published a summary of its anticipated analytic agenda for that period. The major components of that agenda are: recent trends in Medicare Part D (prescription drug) spending the processes and information involved in beneficiary enrollment in Medicare the effect of Medicare’s quality measurement and value-based purchasing programs on quality and value the adequacy of Medicare fee-for-service payments and payment recommendations for the upcoming year further analysis of the Medicare Advantage program [...]
Federal Health Policy Update for August 27
Don’t Miss: Homeland Security proposes new six-figure H-1B visa fee CMS announces refinement of critical access hospital status evaluation HHS seeks feedback on relative of childhood vaccines The following is the latest health policy news from the federal government for August 21-27. Some of the language used below is taken directly from government documents. Congress The House will return from recess next Monday, August 31 and the Senate returns on September 14. Funding for the federal government expires after September 30. H-1B Visas The Department of Homeland Security has issued [...]
Proposed Visa Fee Brings Mixed News for Health Care Interests
The Department of Homeland Security’s proposed $103,265 fee for all H-1B cap-subject visa petitions is good news for some health care organizations and not-so-good news for others – and the communities they serve. Under the proposal, the additional fee would not apply to H-1B petitions that are not subject to the cap – including those eligible for the advanced degree exemption – such as petitions filed by certain non-profit research organizations, governmental research organizations, and institutions of higher education. On the other hand, a new, six-figure fee – which must [...]
The Implications of New Limits on Medicaid Provider Taxes
Last year’s federal budget reconciliation law, in addition to introducing nearly a trillion dollars in federal health care spending cuts over the next decade, took aim at a tool state governments consider vital in financing their Medicaid programs: provider taxes. For years, states have used provider taxes, typically on some aspect of hospital activity, to help finance their share of their Medicaid programs; currently, 49 of the 50 states have such taxes. Among other benefits, using provider taxes in this manner has enabled states to avoid using more general fund [...]