Medicare

MedPAC Meets

Members of the Medicare Payment Advisory Commission held their latest public meeting on Thursday, September 3 and Friday, September 4. The subjects on the meeting’s agenda were: context for Medicare payment policy issues and potential policy directions in Part D workplan: ambulatory surgical centers examining use of post-acute care services by beneficiaries in fee-for-service Medicare and Medicare Advantage Accuracy of Medicare Advantage risk adjustment at the plan level Go here for summaries of the issues and key points and links to the presentations delivered by MedPAC’s staff. MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While [...]

joe2026-09-08T13:42:21-04:00September 9, 2026|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Medicare Makes COVID-Era Telehealth Flexibility Permanent

The Centers for Medicare & Medicaid Services has made permanent a change in Medicare telehealth policy that was introduced as a temporary flexibility during the COVID-19 public health emergency: permitting most providers to deliver telehealth services from their homes without listing their home address on their Medicare enrollment. According to the new CMS advisory document “Understanding Telehealth and Teleradiology Enrollment,” If you provide telehealth services from your home, but have a physical practice location, you do not need to report your home address on your Medicare enrollment application. You can enroll and bill from your physical practice location as if [...]

joe2026-09-03T15:06:39-04:00September 8, 2026|Medicare, Telehealth|

Federal Health Policy Update for September 3

Don’t Miss: 340B data reporting requirements for Medicare Part D claims data – repository opens October 1 CMS permanently permits providers to deliver telehealth from home without listing home address on Medicare enrollment application The following is the latest health policy news from the federal government for August 28-September 3. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services (CMS) CMS is preparing to launch a new Medicare Part D Claims Data 340B Repository on October 1. The 340B data repository will be a centralized, federally managed information system that will [...]

joe2026-09-03T17:26:34-04:00September 3, 2026|340b, Centers for Medicare & Medicaid Services, Congress, COVID-19, hospitals, Medicaid, Medicare, Medicare regulations, MedPAC, Telehealth|

CMS Sets Soft Launch for 340B Data Repository

The Centers for Medicare & Medicaid Services will launch a new Medicare Part D Claims Data 340B Repository on October 1. The agency’s 340B data repository will be a centralized, federally managed information system that will collect, store, and process specific claim-level utilization data for prescription drugs dispensed under the Medicare Part D benefit that also are subject to discounts through the 340B Drug Pricing Program. CMS developed the repository to support implementation of the Medicare Prescription Drug Inflation Rebate Program, which was mandated by the Inflation Reduction Act of 2022. Under this program, the federal government must exclude drug [...]

joe2026-09-02T12:49:27-04:00September 3, 2026|340b, Medicare|

Prior Authorization Remains a Challenge

Getting timely prior authorization for needed medical care continues to pose a problem for patients and providers. Despite federal government action to address prior authorization concerns associated with health care programs it oversees – Medicare Advantage, Medicaid and CHIP fee-for-service and managed care plans, and Affordable Care Act Marketplace plans – and the insistence of some insurers that they have been addressing the issue, problems persist. According to a recent analysis by KFF (quoted directly): Medicare Advantage insurers denied 12% of standard prior authorization requests, Medicaid managed care insurers denied 14%, and ACA Marketplace insurers denied 18%. Denial rates for [...]

joe2026-08-27T16:21:27-04:00September 1, 2026|Affordable Care Act, Medicaid, Medicaid managed care, Medicare|

MedPAC Looks to the Year Ahead

In anticipation of the start of its 2026-2027 public meeting cycle next month, the Medicare Payment Advisory Commission has published a summary of its anticipated analytic agenda for that period. The major components of that agenda are: recent trends in Medicare Part D (prescription drug) spending the processes and information involved in beneficiary enrollment in Medicare the effect of Medicare’s quality measurement and value-based purchasing programs on quality and value the adequacy of Medicare fee-for-service payments and payment recommendations for the upcoming year further analysis of the Medicare Advantage program Learn more from this MedPAC message to its constituents.

joe2026-08-27T11:30:47-04:00August 31, 2026|Medicare, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for August 27

Don’t Miss: Homeland Security proposes new six-figure H-1B visa fee CMS announces refinement of critical access hospital status evaluation HHS seeks feedback on relative of childhood vaccines The following is the latest health policy news from the federal government for August 21-27. Some of the language used below is taken directly from government documents. Congress The House will return from recess next Monday, August 31 and the Senate returns on September 14. Funding for the federal government expires after September 30. H-1B Visas The Department of Homeland Security has issued a notice of proposed rulemaking calling for a $103,265 fee [...]

joe2026-08-27T16:40:49-04:00August 27, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for August 20

Don’t Miss: Latest No Surprises Act/Independent Dispute Resolution news Dept of Homeland Security issues guidance on “public charge” The following is the latest health policy news from the federal government for August 14-20. Some of the language used below is taken directly from government documents. Congress Thirty Senate Democrats have written to HHS Secretary Kennedy seeking to reverse the cancellation of health research grants administered by the Agency for Healthcare Research and Quality (AHRQ). For more information, see the letter here. Congress remains in recess; the House is expected to return on August 31 and the Senate on September 14. [...]

joe2026-08-20T15:55:42-04:00August 20, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Mandatory Value-Based Programs Increase Hospital Costs

While policymakers continue to pursue mandatory Medicare value-based programs at least in part to help reduce taxpayers’ costs for Medicare, they may be robbing Peter to pay Paul. According to a new study, hospitals that participate in federally mandated Medicare value-based purchasing programs face increased administrative costs for doing so even while federal agencies maintain that the programs are saving taxpayer money. Brown University researchers examined 15 years of hospital cost reports and found that participation in Medicare’s Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, and Hospital-Acquired Condition Reduction Program cost hospitals about $650,000 a year in added administrative [...]

joe2026-08-13T16:41:29-04:00August 17, 2026|hospitals, Medicare|

Federal Health Policy Update for August 13

Don’t Miss: Federal court vacates key aspect of No Surprises Act’s IDR process President calls for changes in childhood immunizations CMS seeks billing info so it can pay APM docs their bonuses The following is the latest health policy news from the federal government for August 7-13. Some of the language used below is taken directly from government documents. The White House The White House has issued an executive order calling for a change in recommended childhood vaccines. The order suggests reducing the number of recommended childhood vaccines from the current 17 to 11 revising the status of the remaining [...]

joe2026-08-13T14:39:23-04:00August 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|