Medicaid regulations for long-term care

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|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. The following is MACPAC’s own summary of its two days of public meetings. MACPAC’s March meeting began with a discussion on the role of automation in the Medicaid prior authorization (PA) process. MACPAC conducted a literature review, a federal policy review, and stakeholder interviews on the role of automation in the PA process. During this session, we reviewed findings and challenges that surfaced in this research, including the extent to which automation is already in use in Medicaid PA; the availability of information and documentation [...]

joe2026-03-12T15:08:27-04:00March 16, 2026|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care|

Medicare, Medicaid Regulations Logjam Should Soon End

The shutdown of the federal government brought the usual flow of Medicare and Medicaid regulations to an almost complete halt. Now that the shutdown has ended, the logjam should end fairly quickly – and with a sense of urgency. Currently, a number of major Medicare and Medicaid regulations remain with the Office of Management and Budget for review. Even though the shutdown has now ended, it is not yet clear when they will be addressed. By statute, the following regulations must be implemented by January 1. CY 2026 Hospital Outpatient Prospective Payment System Policy Changes and Payment Rates and Ambulatory [...]

joe2025-11-13T17:00:30-05:00November 18, 2025|Alternative payment models, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for April 25

The following is the latest health policy news from the federal government for April 9-25. Some of the language used below is taken directly from government documents. Updated 340B Arbitration Process Last week HHS’s Health Resources and Services Administration (HRSA) published a regulation modifying the administrative dispute resolution (ADR) process it uses to adjudicate payment disputes between 340B-eligible providers and pharmaceutical companies. The major changes in the ADR process include the use of HRSA experts to serve on ADR panels; elimination of the $25,000 damage threshold for filing a claim; 340B-eligible providers may now challenge manufacturers that seek to prevent [...]

joe2024-04-25T20:25:44-04:00April 25, 2024|340b, Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care, Medicaid regulations for the disabled, Medicare, Medicare post-acute care, Medicare regulations, post-acute care|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days recently in Washington, D.C. The following is MACPAC’s own summary of the meeting. To kick off MACPAC’s November meeting, the Commission continued its work on denials and appeals in Medicaid managed care with a review of findings from beneficiary focus groups. Medicaid managed care organizations (MCOs) manage and provide care to beneficiaries enrolled in their plans. Beneficiaries have the right to appeal MCO coverage decisions. Federal rules require that states have monitoring systems in place to provide oversight of MCOs and their appeals systems. This session described key challenges [...]

iqtsupport2023-11-14T06:00:32-05:00November 14, 2023|Centers for Medicare & Medicaid Services, Congress, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The March 2023 MACPAC meeting began with a staff presentation on potential recommendations for countercyclical disproportionate share hospital (DSH) allotments. Medicaid DSH payments offset hospital uncompensated care costs for Medicaid-enrolled and uninsured patients. During economic recessions, Medicaid enrollment and the number of people who are uninsured increases. During the October 2022 MACPAC meeting, Commissioners agreed that a countercyclical policy should be implemented during future economic recessions, and asked for additional analyses of the effects [...]

iqtsupport2023-03-10T06:00:08-05:00March 10, 2023|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations for long-term care|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The December 2022 MACPAC meeting began with a Commission discussion on two potential recommendations for improving Medicaid race and ethnicity data reporting. As part of its commitment to prioritizing health equity in all of its work, the Commission is focused on how to improve Medicaid race and ethnicity data collection and reporting. In October, staff presented findings from a literature review and key stakeholder interviews, as well as possible approaches for improving the collection [...]

iqtsupport2022-12-15T06:00:20-05:00December 15, 2022|hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care|

Federal Health Policy Update for October 27

The following is the latest health policy news from the federal government for the week of October 21 to October 27. Some of the language used below is taken directly from government documents. 340B Responding to a federal court ruling that the federal government has shortchanged hospitals in its payments for 340B-covered prescription drugs, CMS has announced how it will compensate hospitals for its underpayments – at least for the 2023 fiscal year. According to CMS, it “…will apply the default rate (generally ASP plus 6%) to 340B-acquired drugs for the rest of the year. CMS also will reprocess claims [...]

iqtsupport2022-10-27T17:06:24-04:00October 27, 2022|340b, Center for Medicare and Medicaid Innovation, CMMI, COVID-19, Medicaid, Medicaid regulations for long-term care, Medicare, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for Thursday, June 30

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, June 30. Some of the language used below is taken directly from government documents. White House The White House has unveiled its “White House Blueprint for Addressing the Maternal Health Crisis.” Monkeypox Update The White House has announced the first phase of its national monkeypox vaccine strategy, a part of its monkeypox outbreak response. The major components of the strategy include expanded efforts to vaccinate those most at risk, expanded testing supply and availability, and greater engagement with community leaders and stakeholders. [...]

iqtsupport2022-06-30T17:01:01-04:00June 30, 2022|Centers for Medicare & Medicaid Services, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care, Medicare, Medicare post-acute care, Medicare regulations, MedPAC|

Pennsylvania Considers Screening Would-Be Nursing Home Buyers

Even before the federal government announced that it would release data on hospital and nursing home ownership as a means of casting light on the impact of private equity on provider quality and costs, regulators in Pennsylvania were proposing their own approach by seeking to vet those aspiring to purchase nursing homes in their state. Under nursing home regulations proposed by the Pennsylvania Department of Health, regulators would have an opportunity to examine the past performance and financial strength of entities seeking to purchases nursing homes. As more for-profit entities enter the industry, the department notes, they bring with them [...]

iqtsupport2022-04-27T06:00:06-04:00April 27, 2022|Medicaid regulations for long-term care, Pennsylvania Medicaid, post-acute care|