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Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold [...]

June 18, 2026|Categories: 340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|Tags: 340B, 340B Rebate Model Pilot Program, Affordable Care Act Essential Health Benefits, CDC and infant botulism, CDC and New World screwworm, health care accreditation, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid managed care and maternal health services, Medicaid state plan amendments, Medicare Drug Price Negotiation Program, Medicare Payment Advisory Commission, MedPAC, MedPAC annual report to Congress, MLN Connects, No Surprises Act, pharmacy benefit managers PBMs, section 1115 Medicaid demonstration programs|

Making Sense of New Medicaid Medical Frailty Exemption

The recent release of new Medicaid work and community engagement requirements has raised nearly as many questions as it answers about who will and who will not be eligible for Medicaid when the new criteria take effect next year. While the work and community engagement requirements themselves are relatively straightforward, questions remain about the medical frailty exception and who, based on their medical condition, will be exempt from the work or community engagement requirement. A number of sources have reported on the medical frailty exception. NY Times – “Trump Administration [...]

June 18, 2026|Categories: Medicaid|Tags: Medicaid, medicaid medical frailty exception, medicaid medical frailty exemption, Medicaid work and community engagement requirement|

MACPAC Issues Report to Congress

The Medicaid and CHIP Payment and Access Commission has sent its 2026 report to Congress. The report – mandated by Congress – includes recommendations for: overseeing community engagement/work requirements in Medicaid, including MedPAC’s recommendation that the Centers for Medicare & Medicaid Services develop a transparent plan through which it can monitor and evaluate community engagement requirements improving CMS’s oversight of the use of automation in Medicaid prior authorization decisions improving the accountability of states’ Medicaid managed care programs appropriate access to residential treatment services for Medicaid-enrolled youth with special behavioral [...]

June 17, 2026|Categories: Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care|Tags: MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid and community engagement and work requirement, Medicaid managed care, Medicaid prior authorization, Program of All-Inclusive Care for the Elderly, residential treatment services for Medicaid enrollees, special health needs and Medicaid|

MedPAC Reports to Congress

The Medicare Payment Advisory Commission has issued its annual report to Congress. This year’s report examines: how Medicare payment incentives affect federal spending and the delivery of care and how those incentives can be improved the challenges beneficiaries encounter when deciding on their enrollment in Medicare how Medicare identifies improper payments – and how it can do so more effectively the association between enrollment in Medicare Advantage plans and provider finances access to selected palliative care services under Medicare’s hospice benefit MedPAC is an independent congressional agency that advises Congress [...]

June 17, 2026|Categories: hospitals, Medicare, Medicare reimbursement policy|Tags: Medicare Advantage, Medicare and palliative care, medicare improper payments, Medicare Payment Advisory Commission, Medicare payment incentives, MedPAC|

Federal Health Policy Update for June 11

The following is the latest health policy news from the federal government for June 5-11. Some of the language used below is taken directly from government documents. Don’t Miss: CMS warns more than 500 hospitals for failing to meet price transparency requirements HHS OIG looks at Medicare Advantage rejections of post-acute services Federal court rejects $100,000 H-1B visa fee HHS RFI seeks new approaches, including AI, for treating addiction CMS creates new office to help with tech modernization Congress Some Republican members of Congress continue to plan for a third [...]

June 11, 2026|Categories: Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|Tags: ACCESS Model, Advancing Chronic Care with Effective Scalable Solutions Model, CMS new Office of Health Technology and Products, DEA and medication-assisted treatment, Drug Enforcement Administration and medication-assisted treatment, H-1B visas, Health care transparency, HHS Office of the Inspector General, HHS request for information RFI on addiction treatment, hospital price transparency, House Energy and Commerce Committee Health Subcommittee, Medicaid state plan amendments, Medicare Advantage, Medicare Advantage and prior authorization for post-acute care, Medicare hospice, Medicare Hospital Insurance Trust Fund, Medicare Payment Advisory Commission, MedPAC, MedPAC comments on proposed FY 2027 Medicare inpatient prospective payment system rule, MLN Connects, Presidential Advisory Council on HIV/AIDS, Prior Authorization for Selected Services and Wasteful and Inappropriate Services Reduction Model (WISer), state directed Medicaid payments|

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