Medicare

What the Changing of the Guard May Bring for Health Care

Medicare for all? A reversal of 2025-enacted cuts in Medicaid eligibility. The restoration of some Affordable Care Act health premium subsidies? More drug price negotiations between the federal government and pharmaceutical companies? The restoration of some National Institutes of Health research funding? A closer look at No Surprises Act dispute adjudication? These are among the policy initiatives that may be undertaken next year in the wake of the outcome of the mid-term elections that saw Democrats gain majorities in both the House and Senate next years? Learn more about some of the policy possibilities for the 120th Congress from [...]

joe2026-11-04T11:01:33-05:00November 4, 2026|Affordable Care Act, Congress, Medicaid, Medicare|

Federal Health Policy Update for October 29

Don’t Miss: CMS charts new path for pursuing ACA premium tax credits CMS publishes timeline for implementation of Medicaid changes Court rejects narrow “medically frail” definition for exemption from Medicaid work requirement Inspector General elaborates on new CMS “power to exclude” The following is the latest health policy news from the federal government for October 23-29. Some of the language used below is taken directly from government documents. Congress The House Committee on Oversight and Government Reform announced an investigation into pharmacy benefit managers (PBMs). In letters to CVS Caremark, Express Scripts, and Optum Rx, Chairman James Comer (R-KY) [...]

joe2026-10-29T17:09:21-04:00October 29, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for October 22

Don’t Miss: Senate Finance Democrats release home care RFI New NIH Women’s Health Division Updated “Health Care Fraud Self-Disclosure” protocol The following is the latest health policy news from the federal government for October 16-22. Some of the language used below is taken directly from government documents. Congress Senate Finance Committee Ranking Member Ron Wyden (D-OR) released a Request for Information (RFI) titled “Delivering An Affordable Home Care Guarantee for American Families,” seeking feedback on policy proposals aimed at making home care affordable and accessible, especially for those with disabilities and seniors; improving the quality of care in nursing homes; [...]

sysadmin2026-10-25T16:53:19-04:00October 22, 2026|340b, Centers for Medicare & Medicaid Services, Congress, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare|

GLP-1 Model Popular Among Seniors

It looks like a lot of seniors want help losing weight. That seems like a reasonable conclusion after a Department of Health and Human Services official told a recent gathering that more than one million Medicare beneficiaries have signed up to participate in Medicare’s GLP-1 Bridge Model, which will temporarily reduce the price of the popular weight-loss drug to $50 a month. The program, which operates outside of Medicare Part D plans, is intended to serve as a bridge to CMS’s broader BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model, which was delayed while CMS continues to [...]

joe2026-10-15T14:55:26-04:00October 16, 2026|Medicare|

MedPAC Meets

Members of the Medicare Payment Advisory Commission held their latest public meeting on Thursday, October 8 and Friday, October 9. The subjects on the meeting’s agenda were: Issues affecting the payment accuracy of the physician fee schedule and the clinical laboratory fee schedule Clinician quality initiatives in fee-for-service Medicare Medicare’s late-enrollment penalties Workplan: assessing the accuracy of the skilled nursing facility and home health prospective payment systems Go here for a summary of each of these issues, key points, future action items, and links to MedPAC staff presentations. MedPAC is an independent congressional agency that advises Congress on issues involving [...]

joe2026-10-13T15:02:45-04:00October 14, 2026|Medicare, MedPAC|

Federal Health Policy Update for October 8

Don’t Miss: Latest 340B developments CMS penalizes majority of hospitals for failing to meet Readmissions Reduction Program standards FTC reminds hospitals of price transparency requirements The following is the latest health policy news from the federal government for October 2-8. Some of the language used below is taken directly from government documents. The White House The White House announced that the federal government will make one-time payments of $90 per person to more than 20 million Medicare enrollees – about one-third of Medicare participants – to help them pay their Medicare Part B premiums. Most eligible seniors will receive the [...]

joe2026-10-08T16:40:19-04:00October 8, 2026|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for October 1

Don’t Miss: CMS partners with 37 states to launch Medicaid quality initiative CMS fleshes out GLOBE Model Medicare Part D Claims Data 340B Repository goes live The following is the latest health policy news from the federal government for September 25 - October 1. Some of the language used below is taken directly from government documents. The White House A statement issued by the White House titled “President Trump Takes Historic Action to Eliminate Wasteful and Harmful Spending” includes a series of cuts, or rescissions, of health-related federal expenditures, including $567 million for taxpayer-funded HHS services for non-citizens; $28 million [...]

joe2026-10-07T11:45:36-04:00October 1, 2026|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for September 24

Don’t Miss: CMS plans major cuts in Medicare clinical lab payments Administration reconsiders shifting NIH grant decisions to White House All states enroll in CMS model to reduce prices of selected Medicaid-covered drugs The following is the latest health policy news from the federal government for September 18-24. Some of the language used below is taken directly from government documents. The White House The White House has issued the executive order “Enhancing Program Integrity and Interagency Coordination in the Administration of the H-1B Nonimmigrant Visa Program.” The order increases federal oversight of the H-1B visa program because “The abuse of [...]

joe2026-09-24T15:28:11-04:00September 24, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and homelessness, Medicaid regulations, Medicare, Medicare reimbursement policy|

CMS Eyes Major Cuts in Medicare Clinical Lab Rates

Medicare payments for clinical laboratory services will soon be coming down. The Centers for Medicare & Medicaid Services is working to bring Medicare’s clinical laboratory services rates into line with those paid by commercial insurers. Asserting that Medicare is now paying 16 percent more for clinical lab tests than commercial payers, the agency has posted proposed rates for calendar year 2027 that reflect the beginning of what in some cases will be a multi-year process of aligning public and private lab payments – “aligning” by reducing Medicare payments. Hospital laboratories perform between 40 and 55 percent of laboratory tests. While [...]

joe2026-09-22T17:17:48-04:00September 23, 2026|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for September 17

Don’t Miss: CMS advises on “medical frailty” as qualification for Medicaid eligibility CMS unveils long-anticipated IDR Gateway Medicare ACCESS Model to expand The following is the latest health policy news from the federal government for September 11-17. Some of the language used below is taken directly from government documents. Congress The House Energy & Commerce Committee’s Health Subcommittee held a hearing to discuss bills seeking to modify certain physician payments under Medicare, to address cybersecurity in the health care system, and to expand seniors’ access to care. See the chairman’s opening statement here and find a list of witnesses [...]

joe2026-09-17T16:23:30-04:00September 17, 2026|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|