Medicare

Hospital at Home Proving its Worth?

A new study suggests that hospital at home programs are producing positive results for patients and the health care system. Positive results such as greater comfort for patients, fewer returns to the hospital emergency department within 30 days of discharge, lower in-hospital mortality, reduced costs, and improved outcomes. Serving patients at home also frees hospital beds for sicker patients – an important consideration in communities where hospital occupancy levels are especially high. In hospital at home programs, patients receive acute-care services in their own homes with the help of remote monitoring and home visits by clinicians. One downside so far: [...]

joe2026-05-07T16:56:22-04:00May 12, 2026|hospitals, Medicare, Uncategorized|

The Latest CMS Efforts on Prior Authorization

The Centers for Medicare & Medicaid Services continues to work tackling the challenges posed by health insurers that insist they will not pay for certain medical services unless they authorize those services beforehand. In a new blog post, CMS Administrator Mehmet Oz reviews past, current, and future agency efforts to address the challenges posed by the need to obtain prior authorization for medical services. The latest such step, he notes, is adding electronic prior authorization to the Health Tech Ecosystem. Under this approach, work groups across the spectrum of stakeholders seek to align CMS Interoperability and Prior Authorization Final Rule [...]

joe2026-05-07T14:16:35-04:00May 11, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare|

Federal Health Policy Update for May 7

The following is the latest health policy news from the federal government for May 1-7. Some of the language used below is taken directly from government documents. Congress Congress hopes to pass a reconciliation package to fund Immigration and Customs Enforcement (ICE) and Customs and Border Protection before June 1; lawmakers would then turn to a potential third reconciliation measure to address health care affordability before the mid-term elections. Health care provisions in a potential third reconciliation bill could include expanded access to health savings accounts (HSAs); changes to the rate at which the federal government matches state Medicaid spending [...]

joe2026-05-07T16:06:32-04:00May 7, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for April 30

The following is the latest health policy news from the federal government for April 24-30. Some of the language used below is taken directly from government documents. Congress Yesterday, House Republicans adopted the Senate’s budget resolution, clearing the way for the party-line reconciliation process to move into the drafting phase. The limited budget resolution for Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection instructs the Senate Judiciary and Homeland Security committees to write legislation by May 15. Today, the House passed the Senate’s spending bill to fund the rest of the Department of Homeland Security, including FEMA. [...]

joe2026-04-30T14:21:14-04:00April 30, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Medicare Innovations Foster Focus on Behavioral Health

A number of recent changes in the Medicare program appear designed to make it easier for beneficiaries to pursue behavioral health assistance. Among them: A greater focus on the integration of physical and behavioral health. A greater willingness to pay for digital behavioral health interventions. The release of several requests for information addressing behavioral health services. The introduction of new behavioral health procedure and billing codes. The inclusion of behavioral health in new Medicare models, including the LEAD (Long-Term Enhanced ACO Design) Model, the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, and the MAHA ELEVATE (Make America Healthy [...]

joe2026-04-23T15:06:02-04:00April 27, 2026|ACO, Alternative payment models, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 23

The following is the latest health policy news from the federal government for April 17-23. Some of the language used below is taken directly from government documents. The White House President Trump has issued an executive order calling for accelerated access to medical treatments for patients with serious mental illness, with an emphasis on greater access to psychedelic drugs. Learn more from this executive order and an accompanying White House fact sheet. Shortly after the White House issued this executive order, HHS’s Advanced Research Projects Agency for Health (ARPA-H) announced the first set of research teams for its Evidence-Based Validation [...]

joe2026-04-23T16:43:24-04:00April 23, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 16

The following is the latest health policy news from the federal government for April 11-16. Some of the language used below is taken directly from government documents. CMS – New Proposed Regulations FY 2027 Medicare Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Proposed Rule CMS has published its proposed FY 2027 Medicare hospital inpatient and long-term-care hospital prospective payment system rule. The highlights of the proposed rule are: A 2.4 percent rate increase for both acute-care hospital inpatient and long-term care hospital services. A $564 million reduction in Medicare disproportionate share hospital (Medicare DSH) and [...]

joe2026-04-16T16:21:07-04:00April 16, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for April 10

The following is the latest health policy news from the federal government for April 4-10. Some of the language used below is taken directly from government documents. Congress The House and Senate were in recess this week and are scheduled to be back in session on April 14. House Speaker Mike Johnson (R-LA) has indicated that the House will not vote on the Senate‑passed Department of Homeland Security continuing resolution until there is meaningful progress on a reconciliation package to fund U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection. In an effort to narrow the scope [...]

joe2026-04-10T13:43:20-04:00April 10, 2026|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|

Medicare Increases Emphasis on Behavioral Health

Medicare policy is evolving to encourage providers to take a more active role in addressing the behavioral health needs of their patients. In traditional Medicare, new payment codes encourage practitioners to spend more time identifying and helping patients with their behavioral health challenges. Meanwhile, CMS and its Center for Medicare and Medicaid Innovation have introduced several new care and payment models that place a greater emphasis on beneficiaries’ behavioral health needs. Among them: The LEAD (Long-Term Enhanced ACO Design) Model, which seeks to include more behavioral health providers and encourages greater integration of behavioral health care. The ACCESS (Advancing Chronic [...]

joe2026-03-31T17:02:07-04:00April 1, 2026|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare|

Federal Health Policy Update for March 26

The following is the latest health policy news from the federal government for March 20-26. Some of the language used below is taken directly from government documents. Congress Republican leadership is exploring a reconciliation bill as a potential vehicle to fund Immigrations and Customs Enforcement (ICE) and pass the Safeguard American Voter Eligibility Act (SAVE) voting rights act. If pursued, this approach could increase the likelihood of additional health care cuts, including expanding site-neutral payment policies in both Medicare and Medicaid. It is not clear whether there will be sufficient support in either chamber for Republicans to pursue a party-line [...]

joe2026-03-26T15:09:34-04:00March 26, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare regulations, Medicare reimbursement policy|