Accountable Care Organization

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 on promoting choice and competition in their health care markets [...]

joe2025-09-04T17:31:02-04:00September 9, 2025|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|

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 that also expire after September 30, including for telehealth flexibilities, [...]

joe2025-09-04T15:15:10-04:00September 4, 2025|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|

Federal Health Policy Update for July 17

The following is the latest health policy news from the federal government for July 11-17. Some of the language used below is taken directly from government documents. Proposed Medicare Outpatient Prospective Payment and Ambulatory Surgical Center Payment System Regulation for CY 2026 CMS has published its proposed Medicare outpatient prospective payment and ambulatory surgical center payment system rule for CY 2026. Highlights include: A 2.4 percent increase in outpatient rates that is offset by a two percentage point clawback under the 340B final remedy rule, making the actual increase just 0.5 percent. A site-neutral payment policy for the outpatient administration [...]

joe2025-07-17T14:50:40-04:00July 17, 2025|340b, Accountable Care Organization, ACO, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care, social determinants of health, Telehealth|

Federal Health Policy Update for May 29

The following is the latest health policy news from the federal government for May 23-29. Some of the language used below is taken directly from government documents. Congress The House and Senate are out of Washington, D.C. this week for the Memorial Day holiday and will return to Washington on June 3. Senate Republican staff is working on the House-passed reconciliation bill to identify provisions that may need to change or be excluded to comply with the Senate’s rules for reconciliation bills. At the same time, some Republican senators have expressed opposition to the House reconciliation bill; some maintain that [...]

joe2025-05-29T15:36:56-04:00May 29, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Innovation Center to Steer New Course

The Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation has announced that it will take a new approach to developing and testing new models of health care delivery – an approach designed to be more MAHA-oriented. The Innovation Center intends to place a greater emphasis on disease and chronic condition prevention built around what it calls “three interrelated pillars:” promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition. The agency says it “…will focus on models that show the greatest promise for generating savings and improving quality.” Specifically, the Innovation [...]

joe2025-05-15T16:13:40-04:00May 19, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare|

Federal Health Policy Update for May 15

The following is the latest health policy news from the federal government for May 9-15. Some of the language used below is taken directly from government documents. Congress: Reconciliation House Energy and Commerce Committee Charged with finding $880 billion in federal spending cuts over the next ten years, the House Energy and Commerce Committee this week produced legislative language to be included in a House reconciliation bill that would achieve that objective. The committee’s cost-cutting provisions include: Freezing state Medicaid provider taxes at their current level, prohibiting the establishment of new provider taxes, modifying the criteria CMS uses to determine [...]

joe2025-05-15T17:19:56-04:00May 15, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, deficit reduction, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations, Medicare, Medicare cuts, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for May 8

The following is the latest health policy news from the federal government for May 2-8. Some of the language used below is taken directly from government documents. Congress Reconciliation Over the past several days the political gravity surrounding Medicaid cuts has begun to shift slightly. Moderate Republicans have been pushing back more forcefully and more loudly against such cuts, with some saying they will not support more than work requirements and increased enforcement checks for eligibility. Opposition to most Medicaid cuts led the Energy and Commerce Committee to delay a markup of its reconciliation bill planned for this week to [...]

joe2025-05-08T16:50:48-04:00May 8, 2025|Accountable Care Organization, Alternative payment models, Congress, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 17

The following is the latest health policy news from the federal government for April 11-17. Some of the language used below is taken directly from government documents. The White House President Trump signed an executive order titled “Lowering Drug Prices by Once Again Putting Americans First” that directs the Secretary of the Department of Health and Human Services to take steps to lower prescription drug costs for patients. The order addresses several prescription drug-related policies, including: the Medicare Drug Price Negotiation Program seeking better Medicare prices for drugs not subject to the Medicare Drug Price Negotiation Program accelerating FDA drug [...]

joe2025-04-17T17:14:31-04:00April 17, 2025|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for February 13

The following is the latest health policy news from the federal government for February 7 - 13. Some of the language used below is taken directly from government documents. Introduction With the pause in external communication that the new administration imposed on HHS three weeks ago, including announcements, advisories, regular publications, and web site updates, there has been very little public communication from or activity involving HHS in the past week. While an HHS spokesperson explained that the moratorium has been eased and agencies are now permitted to engage in some public communication, subject to review, such activity remains very [...]

Federal Health Policy Update for January 16

The following is the latest health policy news from the federal government for January 11-17. Some of the language used below is taken directly from government documents. Congress House Budget Committee Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending by between $5.3 trillion and $5.7 trillion over a period of ten years. Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending. The health care cuts the document lists (all figures are ten-year reductions) are: Medicare introducing Medicare site-neutral outpatient payments - [...]