Bulletin Board

Federal Health Policy Update for July 10

The following is the latest health policy news from the federal government for July 4-10. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has posted an FAQ on inpatient hospital reviews with an emphasis on short hospital stays and its MAC Targeted Probe and Educate (TPE) program. Find that FAQ here. Department of Health and Human Services HHS has rescinded a 1998 interpretation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) that extended certain federal [...]

July 10, 2025|Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicare|Tags: access to obstetric services, Hospitals closing obstetric services, rural hospitals closing obstetric services|

States Mull Response to Reconciliation Bill’s Medicaid Cuts

Establishing new grant programs for hospitals, especially for rural hospitals. Reducing or eliminating optional Medicaid benefits such as dental and vision. Cutting payments to providers. Calling their legislature back into session. These are among the moves states are considering in the wake of passage of the FY 2026 budget reconciliation bill that results in hospitals facing a loss of approximately 18 percent of their Medicaid funding over the next decade. Learn more about some the Medicaid financial challenges states now face and how they are considering responding to them in [...]

July 9, 2025|Categories: Medicaid|Tags: cutting Medicaid provider payments, FY 2026 budget reconciliation, grants for rural hospitals, Medicaid cuts, Medicaid financial challenges, optional Medicaid benefits|

Federal Health Policy Update for July 3

The following is the latest health policy news from the federal government for June 27 – July 3. Some of the language used below is taken directly from government documents. Congress/Budget Reconciliation After more than 36 hours of intense lobbying by the administration and House Republican leadership and an all-night legislative session that carried well into Thursday afternoon, the House approved the Senate-passed version of H.R. 1, the reconciliation bill, by a vote of 218-214. Voting was almost entirely along party lines, with all House Democrats voting against it and [...]

July 3, 2025|Categories: 340b, Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|Tags: 2026 Medicare physician payments, 340B, access to Medicaid dental services for people with intellectual and developmental disabilities, access to Medicaid services for people with intellectual and developmental disabilities, Affordable Care Act mandatory covered preventive health services, CMS approved Medicaid state plan amendments, CMS Wasteful and Inappropriate Service Reduction Model, CMS WISeR model, Department of Justice-Department of Health and Human Services False Claims Act Working Group, Federal FY 2025 budget reconciliation, federal Medicaid matching funds, FY 2025 Medicare hospital outpatient prospective payment system rate update, FY 2025 Medicare inpatient prospective payment system rate update, HHS Office of the Inspector General, House reconciliation bill, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH cuts, Medicaid eligibility redetermination, Medicaid managed care state directed payments, Medicaid provider taxes, Medicaid retroactive eligibility, Medicaid state directed payments, Medicaid work requirements, Medicare beneficiary data breach, Medicare end-stage renal disease prospective payment system, Medicare home health prospective payment system, proposed 2026 Medicare end-stage renal disease prospective payment system rates, proposed 2026 Medicare prospective payment system rates, Senate reconciliation bill, traditional Medicare prior authorization|

Health Care Implications of Senate Reconciliation Bill

On Tuesday the Senate passed an FY 2026 budget reconciliation bill by a vote of 51-50, with Vice President Vance casting the tie-breaking vote. The bill cuts $1 trillion in Medicaid spending and keeps most of the Medicaid provisions included in the version released by the Senate Finance Committee in mid-June. The bill passed by the Senate creates a fund for rural providers of $50 billion over five years. The major Medicaid provisions in the bill include: A freeze on the size of Medicaid provider taxes, phased down reductions of [...]

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 [...]

July 2, 2025|Categories: Centers for Medicare & Medicaid Services, CMMI, Medicare, Medicare reimbursement policy|Tags: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, CMS, Medicare, Medicare prior authorization, Wasteful and Inappropriate Service Reduction Model, WISeR|

Bulletin Board

Bulletin Board

Categories

Recent Posts

Archives