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CMS Eyes Major Cuts in Medicare Clinical Lab Rates

Medicare payments for clinical laboratory services will soon be coming down. The Centers for Medicare & Medicaid Services is working to bring Medicare’s clinical laboratory services rates into line with those paid by commercial insurers. Asserting that Medicare is now paying 16 percent more for clinical lab tests than commercial payers, the agency has posted proposed rates for calendar year 2027 that reflect the beginning of what in some cases will be a multi-year process of aligning public and private lab payments – “aligning” by reducing Medicare payments. Hospital laboratories [...]

September 23, 2026|Categories: Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare reimbursement policy|Tags: Medicare, Medicare clinical laboratory payments, Medicare clinical laboratory rates, Medicare reimbursement|

Immigrant Families Skipping Health Care for Kids

Immigrant families with children appear to be avoiding seeking health care over concern about their immigration status, according to a new survey of pediatricians. The survey, conducted on behalf of the American Academy of Pediatrics, found that: Forty percent of pediatricians reported that immigrant families with children are avoiding seeking care for their children because of concern about their immigration status. Thirty-one percent said those same families were avoiding applying for any government programs, including Medicaid, the Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program (SNAP). More [...]

September 21, 2026|Categories: Medicaid|Tags: immigrants and Medicaid and CHIP, immigrants and public charge regulations, Pediatricians and immigrant patients|

Federal Health Policy Update for September 17

Don’t Miss: CMS advises on “medical frailty” as qualification for Medicaid eligibility CMS unveils long-anticipated IDR Gateway Medicare ACCESS Model to expand The following is the latest health policy news from the federal government for September 11-17. Some of the language used below is taken directly from government documents. Congress The House Energy & Commerce Committee’s Health Subcommittee held a hearing to discuss bills seeking to modify certain physician payments under Medicare, to address cybersecurity in the health care system, and to expand seniors’ access to care. See the [...]

September 17, 2026|Categories: Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|Tags: CMS AHEAD Model, CY 2027 Medicare physician fee schedule, FY 2027 Medicare inpatient prospective payment system, FY 2027 Medicare long-term-care hospital prospective payment system, HR 4093 Apples to Apples Comparison Act of 2025, HRSA Rural Maternal Health Data Support Program, IDR Gateway, independent dispute resolution, low-volume hospital criteria, Medicaid eligibility, Medicaid state plan amendments, medical frailty and Medicaid eligibility, Medicare ACCESS Model, Medicare Advancing Chronic Care with Effective, Medicare Advantage, Medicare area wage index, Medicare disproportionate share, Medicare DSH, Medicare Part D plans, Medicare Payment Advisory Commission, Medicare physician payments, Medicare post-acute transfer policy, MedPAC, MLN Connects, No Surprises Act, Office of Minority Health DRIVE, Quality Innovation Network-Quality Improvement Organization QIN-QIO, Rural Health Transformation Program funding, Scalable Solutions Model, U.S. Preventive Services Task Force|

Hospitals Continue to Struggle with Price Transparency

Since the beginning of 2021, hospitals have been required to make their prices transparent to the public. Five years later, roughly half of them do – more than at any point since the requirement took effect. But that also means that roughly half of them still do not. Under the law, hospitals are required to make their prices public via machine-readable files that show standard charges, gross prices, negotiated rates with specific payers, discounted cash prices, and prices for the 300 most commonly provided hospital services. Progress toward achieving this [...]

September 17, 2026|Categories: hospitals|Tags: hospital price transparency, hospital price transparency requirements, hospitals|

CMS Fleshes Out “Medical Frailty” Criterion for Medicaid Eligibility

When Congress included major reductions in Medicaid eligibility in last year’s budget reconciliation bill – H.R. 1, often referred to as the “One Big Beautiful Bill Act” – it included one criterion for Medicaid eligibility that immediately proved challenging. While the new law requires individuals to work or participate in “community engagement” activities such as attending school or performing volunteer work” as a condition of Medicaid eligibility, it offered an exception to this requirement: those found to be “medically frail.” The law, however, did little to define what constitutes medical [...]

September 16, 2026|Categories: Medicaid|Tags: CMS guidance on Medicaid eligibility, CMS guidance on medical frailty and Medicaid eligibility, Medicaid eligibility and medical frailty, Medicaid eligibility criteria, One Big Beautiful Bill Act and Medicaid eligibility|

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