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|

Federal Health Policy Update for August 6

The following is the latest health policy news from the federal government for July 31 to August 6. Some of the language used below is taken directly from government documents.CongressThe Senate is expected to vote on its version of a continuing resolution (CR) before leaving for recess; it would extend federal government funding through December 11. Notably, the legislation includes language that would prevent the Office of Management and Budget from moving forward with its proposed change in how federal grants are awarded and overseen.Because appropriations bills have not cleared both chambers of Congress, the federal government faces a September [...]

joe2026-08-17T15:33:55-04:00August 6, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for July 30

Don’t Miss: Two new final Medicare payment rules CMS seeks data on 340B prescriptions Agency seeks potentially confidential ER data The following is the latest health policy news from the federal government for July 24-30. Some of the language used below is taken directly from government documents. Congress Senate Republicans remain focused on advancing a short-term continuing resolution (CR) before the August recess; it is expected to differ from the CR the House passed last week. The Senate appears unlikely to consider a budget resolution for a third party-line reconciliation bill before September. The Senate Budget Committee announced a hearing [...]

joe2026-07-30T15:52:57-04:00July 30, 2026|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

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|