Centers for Medicare & Medicaid Services

MACPAC Issues Report to Congress

The Medicaid and CHIP Payment and Access Commission has sent its 2026 report to Congress. The report – mandated by Congress – includes recommendations for: overseeing community engagement/work requirements in Medicaid, including MedPAC’s recommendation that the Centers for Medicare & Medicaid Services develop a transparent plan through which it can monitor and evaluate community engagement requirements improving CMS’s oversight of the use of automation in Medicaid prior authorization decisions improving the accountability of states’ Medicaid managed care programs appropriate access to residential treatment services for Medicaid-enrolled youth with special behavioral health needs and disabilities facilitating the transition of children and [...]

joe2026-06-17T09:45:11-04:00June 17, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care|

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|

CMS Warns Hospitals About Price Transparency

The Centers for Medicare & Medicaid Services has written to more than 500 hospitals, warning them that they are failing to meet federal requirements for price transparency. The letter warns hospitals that they are at risk of fines if they do not publicly provide more and better price information. Some have been told they must submit improvement plans. CMS’s view is that the lack of price transparency prevents consumers from comparing hospitals’ prices for services. Learn more about the CMS warning and find a link to a list of the hospitals that have been warned in the AP article “Trump [...]

joe2026-06-09T17:20:07-04:00June 10, 2026|Centers for Medicare & Medicaid Services, hospitals|

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 May 28

The following is the latest health policy news from the federal government for May 22-28. Some of the language used below is taken directly from government documents. Congress When Congress returns from the Memorial Day recess next week, lawmakers will have to address the Republican-led reconciliation bill to fund ICE and CBP. After, they plan to start working on a third party-line bill focusing on affordability—including health care—which leadership aims to pass by the end of July. Next week, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies is scheduled to mark up its Fiscal [...]

sysadmin2026-05-28T17:43:32-04:00May 28, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for May 21

The following is the latest health policy news from the federal government for May 15-21. Some of the language used below is taken directly from government documents. Congress The House Ways and Means Committee marked up several health care bills addressing issues such as durable medical equipment (DME) and home health fraud. A discussion draft that would have required non-profit hospitals and health systems to provide additional reporting on community benefit spending was removed from the list of measures considered. See all the marked-up bills and a recording of the meeting on the committee’s website here. Ways & Means expects [...]

joe2026-05-21T16:10:09-04:00May 21, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicaid managed care, Medicaid regulations, Medicare reimbursement policy|

A Closer Look at the Proposed Drug Prior Authorization Regulation

Last month, the Centers for Medicare & Medicaid Services proposed new requirements for the prior authorization of drugs for patients served by Medicare Advantage, Medicaid, CHIP, and qualified health plans in the federal marketplace. This proposal represented a next step to requirements CMS laid out in 2024 when it called on payers to offer electronic prior authorization for medical services and to respond to providers within required timeframes: seven days for standard requests and 72 hours for expedited requests. Now, CMS proposes requiring these payers to meet these standards through electronic prior authorization for drugs covered under their plans’ pharmacy [...]

joe2026-05-12T17:18:03-04:00May 14, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare|

The Latest CMS Efforts on Prior Authorization

The Centers for Medicare & Medicaid Services continues to work tackling the challenges posed by health insurers that insist they will not pay for certain medical services unless they authorize those services beforehand. In a new blog post, CMS Administrator Mehmet Oz reviews past, current, and future agency efforts to address the challenges posed by the need to obtain prior authorization for medical services. The latest such step, he notes, is adding electronic prior authorization to the Health Tech Ecosystem. Under this approach, work groups across the spectrum of stakeholders seek to align CMS Interoperability and Prior Authorization Final Rule [...]

joe2026-05-07T14:16:35-04:00May 11, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare|

Federal Health Policy Update for May 7

The following is the latest health policy news from the federal government for May 1-7. Some of the language used below is taken directly from government documents. Congress Congress hopes to pass a reconciliation package to fund Immigration and Customs Enforcement (ICE) and Customs and Border Protection before June 1; lawmakers would then turn to a potential third reconciliation measure to address health care affordability before the mid-term elections. Health care provisions in a potential third reconciliation bill could include expanded access to health savings accounts (HSAs); changes to the rate at which the federal government matches state Medicaid spending [...]

joe2026-05-07T16:06:32-04:00May 7, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

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|