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CMS Tinkers With Models

The Centers for Medicare & Medicaid Services has announced changes in two of its Medicare accountable care models: the Achieving Healthcare Efficiency Through Accountable Design (AHEAD) Model and the Transforming Episode Accountability (TEAM) Model. The AHEAD Model is a state total cost of care model that seeks to drive state and regional health care transformation and multi-payer alignment with the goals of improving the total health of the population involved, promoting competition and choice, enhancing prevention, and empowering patients. Under the changes, states must implement at least two policies focused [...]

September 9, 2025|Categories: Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Medicare, Medicare post-acute care, Medicare reimbursement policy|Tags: Achieving Healthcare Efficiency Through Accountable Design model, AHEAD Model, Medicare 3-night rule, Transforming Episode Accountability Model TEAM model|

Preparations for Rural Health Transformation Program Continue

When Congress enacted its FY 2025 budget reconciliation bill – the so-called “One Big Beautiful Bill” – it recognized that the Medicaid cuts in that legislation could have a damaging effect on some health care providers and the communities they serve and created a five-year, $50 billion “Rural Health Transformation Program” designed to help protect rural hospitals from some of the damage those cuts are expected to cause. Now, federal regulators are working to bring that program to life. The Centers for Medicare & Medicaid Services, which will administer the [...]

September 8, 2025|Categories: Medicaid|Tags: Center for Medicare & Medicaid Services, Medicaid cuts, Rural Health Transformation Program|

Federal Health Policy Update for September 4

The following is the latest health policy news from the federal government for August 29 – September 4. Some of the language used below is taken directly from government documents. Congress The House and Senate have returned to Washington D.C., where their focus has turned to funding for the federal government, which expires on September 30. Senior appropriators predict that Congress will pass a continuing resolution (CR) to keep the government open through at least mid-November. We expect any CR to include a number of health care extenders for programs [...]

September 4, 2025|Categories: Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|Tags: Achieving Healthcare Efficiency Through Accountable Design model, Acute Hospital Care at Home program, AHEAD Model, approved Medicaid state plan amendments, catastrophic health insurance, CMS technical expert panel, electronic clinical quality measures eCQMs, enhanced premium tax credits, health care extenders, health data blocking, Health Data Technology and Interoperability rule, health insurance hardship exemption, HT1-4 rule, Medicaid disproportionate share, Medicaid DSH, Medicare dependent hospital program, Medicare low-volume hospital program, Medicare Payment Advisory Commission, Medicare sequestration, MedPAC, MedPAC and end-stage renal disease payments, MLN Connects, PAYGO, Rural Health Transformation Program, TEAM model, telehealth, Transforming Episode Accountability Model|

House to Mull Cutting HHS Budget

The House Appropriations Committee has released a new budget proposal that would reduce the Department of Health and Human Services’ budget by six percent in the coming year. Overall, the proposal calls for reducing HHS’s discretionary budget by $13.7 billion. Much of that cut would come from a proposed reduction of 19 percent in the budget of the Centers for Disease Control and Prevention. The proposed budget also calls for $100 million for Make America Healthy Again (MAHA) funding; the elimination of the Agency for Healthcare Research and Quality; and [...]

September 3, 2025|Categories: Congress|Tags: Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention proposed budget, FY 2026 Health and Human Services proposed budget, House Appropriations Committee, proposed FY 2026 discretionary budget for the Department of Health and Human Services, proposed FY 2026 HHS discretionary budget|

Federal Health Policy Update for August 28

The following is the latest health policy news from the federal government for August 22-28. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess and will return to Washington D.C. on September 2. Funding for the federal government expires on September 30, as will a number of health care extenders, including for telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to reductions to Medicaid disproportionate share (Medicaid DSH) allotments. [...]

August 28, 2025|Categories: Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|Tags: Acute Hospital Care at Home, dual eligible cost-sharing, eCQMs, electronic clinical quality measures, FDA Adverse Event Reporting System, HHS Inspector General, ICD-10 coding revisions, Long-term services and supports, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid Drug Rebate Program, Medicaid DSH, Medicaid state plan amendments, Medicare crossover policies, Medicare home health payments, Medicare Payment Advisory Commission, MedPAC, MLN Connects, Rural Health Transformation Program, telehealth|

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