Medicare

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|

Federal Health Policy Update for September 10

Don’t Miss: Energy and Commerce to weigh multiple health care bills HRSA shares upcoming 340B administrative changes CMS continues distributing Rural Health Transformation Program $$$ The following is the latest health policy news from the federal government for September 4-10. Some of the language used below is taken directly from government documents. The White House The White House announced that the federal government will issue refunds of $500 a person to nearly one million Americans who it says were overcharged for Affordable Care Act exchange health plans because their premiums included user fees that were charged to cover the cost [...]

joe2026-09-10T14:54:12-04:00September 10, 2026|340b, Affordable Care Act, Center for Medicare and Medicaid Innovation, CMMI, Congress, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

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 and go here for a transcript of the two-day session. MedPAC is an independent [...]

joe2026-09-09T12:41:01-04:00September 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|