Medicare reimbursement policy

Federal Health Policy Update for August 21

The following is the latest health policy news from the federal government for August 15-21. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess and will return to Washington D.C. on September 2. Funding for the federal government expires on September 30, as will a number of health care extenders, including for telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments. In the fall, Congress is considering pursuing health care legislation along two [...]

joe2025-08-21T14:43:11-04:00August 21, 2025|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare reimbursement policy, post-acute care, Telehealth|

Putting Some Meat on CMS’s WISeR Bones

In June, the Centers for Medicare & Medicaid Services announced a new CMS Innovation Center model: The Wasteful and Inappropriate Service Reduction Model, or WISeR. The idea behind WISeR is for Medicare to seek to reduce waste, fraud, and abuse in the program by working through technology companies to make greater use of prior authorization and pre-payment reviews for a small group of medical items and services that the agency considers susceptible to misuse or unnecessary use. While the program is scheduled to start next January 1 and CMS has chosen a limited number of states – Arizona, New Jersey, [...]

joe2025-08-20T12:50:03-04:00August 20, 2025|Center for Medicare and Medicaid Innovation, CMMI, Medicare, Medicare reimbursement policy|

The Likelihood of Major Medicare Cuts

While the potential for significant Medicaid cuts resulting from passage of the FY 2025 federal budget reconciliation bill – the so-called One Big Beautiful Bill – has received a great detail of attention, the possibility of Medicare cuts as well has flown mostly under the radar. Until now. In a letter to Democratic congressional committee leaders, the Congressional Budget Office has put a price tag on prospective Medicare cuts. According to the CBO, the FY 2025 budget reconciliation bill could lead to more than $500 billion in federal Medicare payment cuts between next year and 2034. The federal “PAYGO” law [...]

joe2025-08-19T14:06:16-04:00August 20, 2025|Medicaid, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for August 14

The following is the latest health policy news from the federal government for August 8-14. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess and will return to Washington D.C. on September 2. Funding for the federal government, along with health care extenders including extensions of telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments, all expire September 30. In the fall, Congress is considering pursuing health care legislation along two tracks, [...]

joe2025-08-14T15:35:41-04:00August 14, 2025|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare post-acute care, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for August 7

The following is the latest health policy news from the federal government for August 2-7. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess. When Congress returns in September its top priority will be funding the federal government before the fiscal year ends on September 30, likely requiring a continuing resolution to avoid a shutdown. Several major health care programs and extenders are set to expire at the end of the fiscal year, including Medicaid disproportionate share (Medicaid DSH) allotments, telehealth flexibilities, the Acute Hospital Care at Home [...]

joe2025-08-07T15:29:33-04:00August 7, 2025|340b, Congress, COVID-19, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for July 31

The following is the latest health policy news from the federal government for July 25-31. Some of the language used below is taken directly from government documents. Congress The House recessed last week and the Senate is still in session. When Congress returns in September its top priority will be funding the federal government before the fiscal year ends on September 30, likely requiring a continuing resolution to avoid a shutdown. Several major health care programs and extenders are set to expire at the end of the fiscal year, including Medicaid DSH allotments, telehealth flexibilities, the Acute Hospital Care at [...]

joe2025-07-31T15:04:29-04:00July 31, 2025|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for July 24

The following is the latest health policy news from the federal government for July 18-24. Some of the language used below is taken directly from government documents. The White House The White House has released its AI action plan. Winning the Race: America’s AI Action Plan is a 28-page document that mentions health care only in passing but includes provisions that could potentially affect the health care industry. Find the plan here. Congress The House has adjourned for recess and will return to Washington after Labor Day. The Senate remains in session, expecting to recess next week. When Congress returns [...]

joe2025-07-24T15:08:24-04:00July 24, 2025|Centers for Medicare & Medicaid Services, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicare, Medicare post-acute care, Medicare reimbursement policy, post-acute care, Telehealth|

OBBB Implementation Timeline

DeBrunner & Associates has prepared a timeline presenting the timeline showing the stages through which the FY 2026 federal budget reconciliation bill (the “One Big Beautiful Bill”) will be implemented. Find it here.

joe2025-07-17T15:53:25-04:00July 21, 2025|Congress, Medicaid, Medicaid regulations, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for July 17

The following is the latest health policy news from the federal government for July 11-17. Some of the language used below is taken directly from government documents. Proposed Medicare Outpatient Prospective Payment and Ambulatory Surgical Center Payment System Regulation for CY 2026 CMS has published its proposed Medicare outpatient prospective payment and ambulatory surgical center payment system rule for CY 2026. Highlights include: A 2.4 percent increase in outpatient rates that is offset by a two percentage point clawback under the 340B final remedy rule, making the actual increase just 0.5 percent. A site-neutral payment policy for the outpatient administration [...]

joe2025-07-17T14:50:40-04:00July 17, 2025|340b, Accountable Care Organization, ACO, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care, social determinants of health, Telehealth|

Federal Health Policy Update for July 3

The following is the latest health policy news from the federal government for June 27 – July 3. Some of the language used below is taken directly from government documents. Congress/Budget Reconciliation After more than 36 hours of intense lobbying by the administration and House Republican leadership and an all-night legislative session that carried well into Thursday afternoon, the House approved the Senate-passed version of H.R. 1, the reconciliation bill, by a vote of 218-214. Voting was almost entirely along party lines, with all House Democrats voting against it and just two Republicans – Brian Fitzpatrick (PA) and Thomas Massie [...]

joe2025-07-03T16:02:05-04:00July 3, 2025|340b, Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|