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MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. The following is MACPAC’s own summary of its two days of public meetings. MACPAC’s September 2025 meeting began with a summary of Public Law 119-21, an Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 (2025 Budget Reconciliation Act, P.L. 119-21). This legislation included several provisions affecting Medicaid and the State Children’s Health Insurance Program (CHIP). In this session, staff provided a summary of the Medicaid and CHIP-related provisions in [...]

September 29, 2025|Categories: Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations|Tags: an Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 (2025 Budget Reconciliation Act, D.C. The following is MACPAC’s own summary of its two days of public meetings. MACPAC’s September 2025 meeting began with a summary of Public Law 119-21, Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, P.L. 119-21). This legislation included several provisions affecting Medicaid and the State Children’s Health Insurance Program (CHIP). In this session|

Federal Health Policy Update for September 25

The following is the latest health policy news from the federal government for September 19-25. Some of the language used below is taken directly from government documents. Federal Funding for Fiscal Year 2026 Telehealth and Acute Hospital Care at Home Program Flexibilities Many current telehealth flexibilities and authorization for the Acute Hospital Care at Home program will expire on September 30 unless Congress extends them. The following is CMS’s current guidance on these programs if they are not extended by September 30: The CMS Acute Hospital Care at Home web [...]

September 25, 2025|Categories: Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, hospitals, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid long-term services and supports, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|Tags: Acute Hospital Care at Home program, approved Medicaid state plan amendments, autism, Autism Data Science Initiative, Behavioral Health Integration Evidence-Based Telehealth Network Program, CDC ACIP, CDC advisory committee on immunization practices, CDC and chickenpox vaccines, CDC and COVID vaccines, CDC and MMRV vaccine, consolidation among physician practices, consolidation in health care, FDA and Barth Syndrome, federal government and autism, federal government shutdown, GAO report on urban hospitals, HB-1 visas, HB-1 visas for doctors and health care professionals, Independent Dispute Resolution entities, long covid, low-volume hospital adjustment program, MACPAC, Medicaid and CHIP and behavioral health, Medicaid and CHIP Payment and Access Commission, Medicaid and foster care, Medicaid and home- and community-based services workforce issues, Medicaid community engagement requirements, Medicaid disproportionate share, Medicaid DSH, Medicaid federal Medical Assistance percentage, Medicaid work requirements, Medicare Advantage provider directories, Medicare Part B and skin substitutes, Medicare Part D Senior Savings Model, MIPS, MLN Connects, No Surprises Act, Office of Management and Budget, provider relief fund, reasons urban hospitals close, Rural Community Hospital Demonstration, State Opioid Response program, telehealth|

Looking at Potential Health Coverage Losses

Changes adopted in the FY 2026 budget reconciliation bill (“the One Big Beautiful Bill” Act) could result in a significant increase in the ranks of the uninsured across the country. According to an Urban Institute analysis supported by the Commonwealth Fund, if current expanded health insurance premium tax credits end with the beginning of the new federal fiscal year on October 1, 4.8 million more people would become uninsured, a 21 percent increase. 3 million fewer people across the U.S. would get subsidized marketplace coverage. Premiums would soar. For people [...]

September 22, 2025|Categories: Affordable Care Act, deficit reduction|Tags: expanded health insurance premium tax credits, FY 2026 budget reconciliation bill, increases in health insurance premiums, increases in the number of uninsured, One Big Beautiful Bill Act, uninsured rates|

Federal Health Policy Update for September 18

The following is the latest health policy news from the federal government for September 12-18. Some of the language used below is taken directly from government documents. Congress Funding for the federal government expires on September 30. Members of Congress have not yet coalesced around a plan to fund the federal government when the new federal fiscal year begins on October 1, with House Republican and Democratic leaders releasing competing legislative texts for a short-term continuing resolution (CR). House Republicans have proposed a CR to last through November 21 with [...]

September 18, 2025|Categories: 340b, Affordable Care Act, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|Tags: 340B, 340B Rebate Model Pilot Program, 340B repayment, Acute Hospital at Home Program, American Medical Association CPT codes, health care extenders, health insurance premium tax credits, Medicaid demonstrations, Medicaid disproportionate share, Medicaid DSH, Medicaid state directed payments, Medicare 2026 outpatient prospective payment system regulation, Medicare area wage index system, Medicare disproportionate share, Medicare DSH, Medicare inpatient-only list, Medicare outpatient payments, Medicare Payment Advisory Commission, Medicare proposed 2026 physician fee schedule rule, Medicare quality reporting programs, Medicare site-neutral outpatient payments, Medicare state plan amendments approved, MedPAC, MLN Connects, nursing home staffing, Patient Safety Organization program, Rural Health Transformation Program, TEFCA, telehealth flexibilities|

Providers Objecting to New HHS Programs

Health care providers are expressing concern about two new programs recently announced by the Department of Health and Human Services: the Centers for Medicare & Medicaid Services’ Medicare WISeR (Wasteful and Inappropriate Service Reduction) Model and HHS’s 340B Rebate Model Pilot Program. The WISeR model, to be tested in six states, will require doctors to obtain prior authorization before providing a limited group of services. That prior authorization is expected to be delivered primarily through the use of AI. Participation will be mandatory in the states involved in the program [...]

September 18, 2025|Categories: 340b, Center for Medicare and Medicaid Innovation, CMMI, Medicare, Medicare reimbursement policy|Tags: 340B, 340B discount drug program, 340B Rebate Model Pilot Program, Center for Medicare and Medicaid Innovation, Medicare Wasteful and Inappropriate Service Reduction Model, Medicare WISeR Model|

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