Medicare

Hospitals to Face More Readmissions Penalties in 2026

Hospital readmissions penalties will increase, as will the size of the typical penalty, in the coming year. Beginning in FY 2026, the proportion of hospitals that will be penalized at least one percent for excessive readmissions under the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program will rise from seven percent of all hospitals to eight percent. The number of hospitals penalized less than one percent will decline. Hospitals that care for the highest proportions of dually eligible Medicare/Medicaid patients will see their penalties increase slightly. The penalties levied in FY 2026 will reflect hospital performance between July [...]

joe2025-09-26T10:48:58-04:00September 30, 2025|Centers for Medicare & Medicaid Services, Medicare|

Federal Health Policy Update for September 25

The following is the latest health policy news from the federal government for September 19-25. Some of the language used below is taken directly from government documents. Federal Funding for Fiscal Year 2026 Telehealth and Acute Hospital Care at Home Program Flexibilities Many current telehealth flexibilities and authorization for the Acute Hospital Care at Home program will expire on September 30 unless Congress extends them. The following is CMS’s current guidance on these programs if they are not extended by September 30: The CMS Acute Hospital Care at Home web page advises stakeholders that The Acute Hospital Care at Home [...]

Federal Health Policy Update for September 18

The following is the latest health policy news from the federal government for September 12-18. Some of the language used below is taken directly from government documents. Congress Funding for the federal government expires on September 30. Members of Congress have not yet coalesced around a plan to fund the federal government when the new federal fiscal year begins on October 1, with House Republican and Democratic leaders releasing competing legislative texts for a short-term continuing resolution (CR). House Republicans have proposed a CR to last through November 21 with very few anomalies, or policy changes, outside of regular spending. [...]

joe2025-09-18T17:11:02-04:00September 18, 2025|340b, Affordable Care Act, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

Providers Objecting to New HHS Programs

Health care providers are expressing concern about two new programs recently announced by the Department of Health and Human Services: the Centers for Medicare & Medicaid Services’ Medicare WISeR (Wasteful and Inappropriate Service Reduction) Model and HHS’s 340B Rebate Model Pilot Program. The WISeR model, to be tested in six states, will require doctors to obtain prior authorization before providing a limited group of services. That prior authorization is expected to be delivered primarily through the use of AI. Participation will be mandatory in the states involved in the program and providers are concerned that it will increase their administrative [...]

joe2025-09-17T12:50:36-04:00September 18, 2025|340b, Center for Medicare and Medicaid Innovation, CMMI, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for September 11

The following is the latest health policy news from the federal government for September 5-11. Some of the language used below is taken directly from government documents. Congress With fewer than three weeks until the end of the federal fiscal year, congressional leaders are beginning to devise a strategy to avoid a federal government shutdown on October 1. Whatever strategy they ultimately adopt will certainly involve some form of continuing resolution (CR). Some conservatives in Congress would like to see a full-year CR that would keep funding at current levels and permit the President to cut spending via rescissions. Appropriators [...]

joe2025-09-11T16:41:56-04:00September 11, 2025|340b, Affordable Care Act, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

MedPAC Meets

MedPAC’s commissioners held their latest public meetings on Thursday, September 4 and Friday, September 5. The subjects on the meetings’ agenda were: Medicare payment operations and improving payment accuracy oversight needed to ensure Medicare’s sustainability: a report from the Government Accountability Office context for Medicare payment policy access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease or cancer the association between changes in Medicare Advantage enrollment and hospital finances Go here for summaries of the issues and key points and links to the presentations delivered by MedPAC staff and go here a transcript [...]

joe2025-09-09T13:26:12-04:00September 10, 2025|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy, MedPAC|

CMS Tinkers With Models

The Centers for Medicare & Medicaid Services has announced changes in two of its Medicare accountable care models: the Achieving Healthcare Efficiency Through Accountable Design (AHEAD) Model and the Transforming Episode Accountability (TEAM) Model. The AHEAD Model is a state total cost of care model that seeks to drive state and regional health care transformation and multi-payer alignment with the goals of improving the total health of the population involved, promoting competition and choice, enhancing prevention, and empowering patients. Under the changes, states must implement at least two policies focused on promoting choice and competition in their health care markets [...]

joe2025-09-04T17:31:02-04:00September 9, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Medicare, Medicare post-acute care, Medicare reimbursement policy|

Federal Health Policy Update for September 4

The following is the latest health policy news from the federal government for August 29 – September 4. Some of the language used below is taken directly from government documents. Congress The House and Senate have returned to Washington D.C., where their focus has turned to funding for the federal government, which expires on September 30. Senior appropriators predict that Congress will pass a continuing resolution (CR) to keep the government open through at least mid-November. We expect any CR to include a number of health care extenders for programs that also expire after September 30, including for telehealth flexibilities, [...]

joe2025-09-04T15:15:10-04:00September 4, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for August 28

The following is the latest health policy news from the federal government for August 22-28. 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 reductions to Medicaid disproportionate share (Medicaid DSH) allotments. Congressional Budget Office (CBO) The CBO has written to congressional [...]

joe2025-08-28T15:48:29-04:00August 28, 2025|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

New Committee to Consider Federal Role in Health Care

The Department of Health and Human Services and Centers for Medicare & Medicaid Services are forming a new committee to “restore patient-driven care.” The group, to be called the “Federal Healthcare Advisory Committee,” will consist of “… experts charged with delivering strategic recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz to improve how care is financed and delivered across Medicare, Medicaid and the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace.” As described in a CMS news release, the scope of the committee’s work will encompass: Actionable policy initiatives to promote [...]

joe2025-08-21T16:38:27-04:00August 25, 2025|Centers for Medicare & Medicaid Services, health care reform, Medicaid, Medicare|