Bulletin Board
Bulletin Board
CMS Introduces First Prior Authorization Program for Traditional Medicare
Some Medicare-covered services will be subject to prior authorization in some parts of the country under a new model to be launched by the Centers for Medicare & Medicaid Services next year. To run from 2026 through 2031, the “Wasteful and Inappropriate Service Reduction Model,” or WISeR, will test a new process for determining whether enhanced technologies, including artificial intelligence, can expedite prior authorization for selected items and services that have been identified by CMS as particularly vulnerable to fraud, waste, abuse, or inappropriate use. The model will not include [...]
State Spending on Medicaid Rising – Fast
The states are experiencing almost unprecedented increases in their Medicaid spending – both more money and a larger share of their overall state budgets. According to a new Pew Research Center report, In fiscal year 2023, the combination of expiring federal COVID-19 pandemic aid, slowing tax revenue growth, and rising costs for Medicaid led to an increase in the share of state revenue dedicated to Medicaid of 17.8%, or $44.4 billion, over the previous year – the largest single-year rise in at least two decades. States spent 15.1% of every [...]
Federal Health Policy Update for June 26
The following is the latest health policy news from the federal government for June 20-26. Some of the language used below is taken directly from government documents. Congress Senate Majority Leader Thune and House Speaker Johnson continue to press for passage of the “One, Big, Beautiful Bill” by July 4, the deadline set by President Trump. Leader Thune had hoped to bring the bill to the Senate floor early this week but continued disagreements over cuts to Medicaid have slowed progress. Earlier this week, in an attempt to assuage senators’ [...]
The Potential Impact of the Senate’s Proposed Medicaid Cuts
After the House passed its FY 2025 budget reconciliation bill the Senate took up its own bill, with the Senate Finance Committee proposing more than $800 billion in Medicaid cuts through a combination of reduced future Medicaid provider taxes, new limits on state directed payments made through Medicaid managed care plans, new Medicaid work requirements, more frequent redetermination of Medicaid eligibility, a shorter period of retroactive eligibility for Medicaid and the Children’s Health Insurance Program, and more. The Senate continues to debate these proposals, with some members believing they are [...]
Study Finds Differences in Medicare Advantage Hospitalization Trends
Patients who participate in Medicare Advantage plans spend more time as hospital inpatients but receive less post-acute care than those in traditional Medicare, a new study has found. According to NORC, a non-partisan research organization at the University of Chicago, Medicare Advantage patients had hospital stays that were 40% longer on average than those with Traditional Medicare, which comes to seven days versus five. In 2022, Medicare Advantage plans discharged fewer patients to post-acute care settings such as skilled nursing or home health compared to patients covered by Traditional Medicare. [...]