Alternative payment models

CMS Touts ACO REACH Model Results

An evaluation commissioned by the Center for Medicare and Medicaid Innovation has found that the agency’s Medicare ACO REACH (Realizing Equity, Access, and Community Health) Model is saving money and improving health care outcomes. A summary of an evaluation of the program’s 2023 performance year explained that The ACO REACH Model is an advanced accountable care organization (ACO) initiative to promote patient-centered care, lower costs, and align payment systems for Original Medicare beneficiaries through ACO risk-sharing and prospective payment. In performance year (PY) 2023, the model showed stronger improvements in quality than prior years and lowered gross spending across all [...]

joe2026-07-16T16:33:57-04:00July 20, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for July 16

Don’t Miss: CMS proposed 2027 physician payment regulation House Ways and Means passes health care bills DHS publishes new, final public charge rule HHS pursues delivery models for potential psychedelic drugs for behavioral health treatment The following is the latest health policy news from the federal government for July 10-16. Some of the language used below is taken directly from government documents. CMS – Proposed 2027 Medicare Physician Fee Schedule Rule CMS has published its proposed physician fee schedule rule for 2027. Highlights include: A proposed reduction in Medicare physician rates. A reduction of payments for evaluation and management (E/M) [...]

joe2026-07-16T16:13:25-04:00July 16, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

HHS Regulatory Agenda Revealed

The federal Office of Management and Budget has posted an updated version of the administration’s 2026 unified regulatory agenda and among the items posted are more than 180 for the Department of Health Services. Among the HHS items are 44 for the Centers for Medicare & Medicaid Services, which administers the Medicare and Medicaid programs. Most of the items are proposed rules, and among the issues CMS is expected to address through regulation during the rest of 2026 are the Medicare inpatient and outpatient prospective payment systems, the Medicare physician fee schedule, Medicaid managed care and state-directed payments, hospital price [...]

joe2026-07-09T14:19:30-04:00July 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold a hearing titled “State Medicaid Program Integrity: Examining Fraud Risks [...]

joe2026-06-18T16:07:51-04:00June 18, 2026|340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for June 11

The following is the latest health policy news from the federal government for June 5-11. Some of the language used below is taken directly from government documents. Don’t Miss: CMS warns more than 500 hospitals for failing to meet price transparency requirements HHS OIG looks at Medicare Advantage rejections of post-acute services Federal court rejects $100,000 H-1B visa fee HHS RFI seeks new approaches, including AI, for treating addiction CMS creates new office to help with tech modernization Congress Some Republican members of Congress continue to plan for a third party-line reconciliation bill to focus on health care affordability. The [...]

joe2026-06-11T16:08:27-04:00June 11, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for June 4

Don’t miss: CMS publishes new Medicaid work/community engagement requirements Energy and Commerce Committee looks at price transparency in health care An AI executive order and Congress prepares to weigh in Price cut: IDR dispute fee to fall from $115 to $15 per dispute The following is the latest health policy news from the federal government for May 29 to June 4. Some of the language used below is taken directly from government documents. Medicaid Work Requirements – Interim Final Rule CMS has published an interim final rule with comment period to implement the Medicaid work and community engagement requirements [...]

joe2026-06-04T16:30:46-04:00June 4, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare|

Federal Health Policy Update for April 30

The following is the latest health policy news from the federal government for April 24-30. Some of the language used below is taken directly from government documents. Congress Yesterday, House Republicans adopted the Senate’s budget resolution, clearing the way for the party-line reconciliation process to move into the drafting phase. The limited budget resolution for Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection instructs the Senate Judiciary and Homeland Security committees to write legislation by May 15. Today, the House passed the Senate’s spending bill to fund the rest of the Department of Homeland Security, including FEMA. [...]

joe2026-04-30T14:21:14-04:00April 30, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Medicare Innovations Foster Focus on Behavioral Health

A number of recent changes in the Medicare program appear designed to make it easier for beneficiaries to pursue behavioral health assistance. Among them: A greater focus on the integration of physical and behavioral health. A greater willingness to pay for digital behavioral health interventions. The release of several requests for information addressing behavioral health services. The introduction of new behavioral health procedure and billing codes. The inclusion of behavioral health in new Medicare models, including the LEAD (Long-Term Enhanced ACO Design) Model, the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, and the MAHA ELEVATE (Make America Healthy [...]

joe2026-04-23T15:06:02-04:00April 27, 2026|ACO, Alternative payment models, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 23

The following is the latest health policy news from the federal government for April 17-23. Some of the language used below is taken directly from government documents. The White House President Trump has issued an executive order calling for accelerated access to medical treatments for patients with serious mental illness, with an emphasis on greater access to psychedelic drugs. Learn more from this executive order and an accompanying White House fact sheet. Shortly after the White House issued this executive order, HHS’s Advanced Research Projects Agency for Health (ARPA-H) announced the first set of research teams for its Evidence-Based Validation [...]

joe2026-04-23T16:43:24-04:00April 23, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 3

The following is the latest health policy news from the federal government for March 27 to April 3. Some of the language used below is taken directly from government documents. Proposed and Final CMS Medicare Regulations Proposed FY 2027 Medicare Inpatient Rehabilitation Facilities Payment Rule CMS has published a proposed rule updating Medicare payment policies and rates for inpatient rehabilitation facilities (IRF) under its IRF prospective payment system and updating the IRF quality reporting program for FY 2027. CMS proposes updating FY 2027 IRF rates by 2.4 percent based on a market basket update of 3.2 percent less a proposed [...]

joe2026-04-03T13:22:10-04:00April 3, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicare regulations, Medicare reimbursement policy|