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|

Federal Health Policy Update for July 23

Don’t Miss: Congress advances health care bills CMS proposes provider tax rule Courts act on ACA changes, 340B The following is the latest health policy news from the federal government for July 17-23. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee held a markup for 29 bills, advancing the following health care transparency measures with bipartisan support: H.R. 9390, Prices on the Wall Act of 2026 H.R. 9393, Lower Costs, More Transparency Act of 2026, part of a package that also includes: H.R. 3514, Improving Seniors’ Timely Access [...]

joe2026-07-23T16:29:15-04:00July 23, 2026|340b, Affordable Care Act, MACPAC, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|

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|

HHS Regulatory Agenda Revealed

The federal Office of Management and Budget has posted an updated version of the administration’s 2026 unified regulatory agenda and among the items posted are more than 180 for the Department of Health Services. Among the HHS items are 44 for the Centers for Medicare & Medicaid Services, which administers the Medicare and Medicaid programs. Most of the items are proposed rules, and among the issues CMS is expected to address through regulation during the rest of 2026 are the Medicare inpatient and outpatient prospective payment systems, the Medicare physician fee schedule, Medicaid managed care and state-directed payments, hospital price [...]

joe2026-07-09T14:19:30-04:00July 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for July 9

Don’t Miss: CMS ends fast track process for Medicaid 1115 waiver renewals HHS publishes 2026 regulatory agenda HHS asks hospitals to sign healthy foods pledge The following is the latest health policy news from the federal government for July 3-9. Some of the language used below is taken directly from government documents. Congress Congress will return to session on July 13. Committees with jurisdiction over health care will continue focusing on legislation that could ultimately be incorporated into a reconciliation package, FY 2027 appropriations legislation, or other end-of-year legislation. Centers for Medicare & Medicaid Services (CMS) In the wake of [...]

joe2026-07-09T14:47:22-04:00July 9, 2026|Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy|

Proposed Medicare Rule Could Hit Hospitals Hard

The Centers for Medicare & Medicaid Services’ proposed 2027 Medicare outpatient prospective payment system rule could pose several serious challenges to hospitals. Among them: A proposed increase of 2.4 percent in payments for outpatient services that could be reduced to only 0.6 percent if CMS adopts its proposal to accelerate its clawback from previous 340B litigation to a three percent reduction. The transition of still more imaging services to site-neutral payments and a prohibition against Medicare outpatient payments for off-campus hospital-based outpatient departments unless each department has its own National Provider Identifier (NPI) and an attestation from the main provider [...]

joe2026-07-07T12:02:42-04:00July 7, 2026|340b, hospitals, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for July 2

Don’t Miss: CMS proposes CY 2027 Medicare outpatient rates, reviving 340B cuts, expanding site-neutral payments CMS calls for modest Medicare home health pay hike, more ways to oust providers Court halts borrowing limit that jeopardized supply of qualified health professionals The following is the latest health policy news from the federal government for June 25-July 2. Some of the language used below is taken directly from government documents. Proposed CY 2027 Medicare Outpatient Prospective Payment and Ambulatory Surgical Center Rule CMS has published its proposed Medicare FY 2027 outpatient and ambulatory surgical center prospective payment system rule. The proposed [...]

joe2026-07-02T16:55:39-04:00July 2, 2026|340b, Accountable Care Organization, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for June 25

Don’t Miss: CMS posts a new presentation on Medicaid eligibility under HR 1 House health subcommittee marks up health care price transparency bills Cassidy proposes 340B bill HRSA announces two maternity-related funding opportunities The following is the latest health policy news from the federal government for June 19-25. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee’s Oversight Subcommittee held a hearing to discuss integrity and fraud risk in state Medicaid programs; witnesses included state Medicaid directors from California, Minnesota, New York, and Ohio. For more information, see the press [...]

joe2026-06-25T17:28:47-04:00June 25, 2026|340b, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold a hearing titled “State Medicaid Program Integrity: Examining Fraud Risks [...]

joe2026-06-18T16:07:51-04:00June 18, 2026|340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|