Policy Updates

Federal Health Policy Update for May 22

The following is the latest health policy news from the federal government for May 16-22. Some of the language used below is taken directly from government documents. Congress: Reconciliation Early Thursday morning the House of Representatives passed its version of an FY 2025 budget reconciliation bill by a vote of 215-214. The bill underwent a number of changes during the hours before its passage and its health care provisions now include $800 billion in Medicaid cuts over the next ten years. The Congressional Budget Office projects that the bill, mostly because of the Medicaid cuts, will lead to 8.6 million [...]

joe2025-05-23T10:22:33-04:00May 23, 2025|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, COVID-19, deficit reduction, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|

Innovation Center to Steer New Course

The Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation has announced that it will take a new approach to developing and testing new models of health care delivery – an approach designed to be more MAHA-oriented. The Innovation Center intends to place a greater emphasis on disease and chronic condition prevention built around what it calls “three interrelated pillars:” promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition. The agency says it “…will focus on models that show the greatest promise for generating savings and improving quality.” Specifically, the Innovation [...]

joe2025-05-15T16:13:40-04:00May 19, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare|

Federal Health Policy Update for May 15

The following is the latest health policy news from the federal government for May 9-15. Some of the language used below is taken directly from government documents. Congress: Reconciliation House Energy and Commerce Committee Charged with finding $880 billion in federal spending cuts over the next ten years, the House Energy and Commerce Committee this week produced legislative language to be included in a House reconciliation bill that would achieve that objective. The committee’s cost-cutting provisions include: Freezing state Medicaid provider taxes at their current level, prohibiting the establishment of new provider taxes, modifying the criteria CMS uses to determine [...]

joe2025-05-15T17:19:56-04:00May 15, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, deficit reduction, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations, Medicare, Medicare cuts, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for May 8

The following is the latest health policy news from the federal government for May 2-8. Some of the language used below is taken directly from government documents. Congress Reconciliation Over the past several days the political gravity surrounding Medicaid cuts has begun to shift slightly. Moderate Republicans have been pushing back more forcefully and more loudly against such cuts, with some saying they will not support more than work requirements and increased enforcement checks for eligibility. Opposition to most Medicaid cuts led the Energy and Commerce Committee to delay a markup of its reconciliation bill planned for this week to [...]

joe2025-05-08T16:50:48-04:00May 8, 2025|Accountable Care Organization, Alternative payment models, Congress, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|

Supreme Court Rejects Medicare DSH Challenge

The Supreme Court has rejected the appeal of a lower court ruling that found that the Centers for Medicare & Medicaid Services did not undercalculate hospitals’ Medicare disproportionate share payments between 2006 and 2009. In the suit, more than 200 hospitals argued that the calculation of Medicare DSH payments should be based on all hospitalized patients who qualify for both Supplemental Security Income (SSI) and Medicare. The Supreme Court disagreed, confirming in a 7-2 decision the ruling of lower courts that SSI should only be included in DSH calculations when Medicare patients receive SSI payments during the same month they [...]

joe2025-05-01T16:43:24-04:00May 5, 2025|Medicare disproportionate share, Medicare DSH|

Federal Health Policy Update for May 1

The following is the latest health policy news from the federal government for April 25 – May 1. Some of the language used below is taken directly from government documents. Congress Reconciliation The House and Senate returned to Washington D.C. this week and House committees have begun marking up reconciliation legislation for submission to the House Budget Committee by May 9. The Energy and Commerce Committee is expected to seek nearly $550 billion in cuts to Medicaid spending and the most likely targets for cuts continue to be work requirements for Medicaid eligibility; more frequent review of Medicaid eligibility; reducing the federal [...]

joe2025-05-01T15:33:24-04:00May 1, 2025|Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|

Medicaid Financing 101

The National Association of Medicaid Directors has published a primer on how Medicaid is financed at the state and federal levels. The background paper describes the federal Medical Assistance percentage – FMAP, the rate at which the federal government provides matching funds for state Medicaid expenditures – how money flows from the federal government to the states, how Medicaid costs are budgeted at the state level, and how states raise their share of their Medicaid costs. It also outlines factors that affect Medicaid spending, such as enrollment, covered benefits, utilization, the cost of services, administrative costs, and the growing demand [...]

joe2025-04-30T10:13:16-04:00May 1, 2025|Medicaid|

Committee Chair Calls for 340B Changes

In a newly released report, Senate Health, Education, Labor and Pensions (HELP) Committee chair Bill Cassidy (R-LA) has pointed to problems with the 340B Drug Pricing Program and suggested ways of dealing with those problems. The report, from the committee’s majority staff, notes that … there are concerns about whether the 340B Program truly benefits low-income and uninsured patients, with some studies suggesting that the 340B benefit does not translate into increased care or lower costs for vulnerable populations. It also outlines potential changes for improving the program, including requiring additional reporting on the use of 340B savings, scrutiny of [...]

joe2025-04-29T16:30:28-04:00April 30, 2025|340b, Congress, Medicaid|

Are Medicaid Provider Taxes, State-Directed Payments in Play?

Even as the House Energy and Commerce Committee contemplates how it will reach its assigned target of $880 billion in spending cuts mostly through Medicaid cuts, the Centers for Medicare & Medicaid Services may be following a similar course by targeting two potential changes that Congress is already thought to be considering: changes in policies governing Medicaid provider taxes and state-directed Medicaid payments. Recently, CMS filed a proposed regulation titled “Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole” to the Office of Management and Budget (OMB) for review. Speculation centers on whether this proposed policy [...]

joe2025-04-24T15:54:20-04:00April 28, 2025|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations|

Federal Health Policy Update for April 24

The following is the latest health policy news from the federal government for April 18-24. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess until April 28. Upon their return to Washington D.C., committees will begin marking up reconciliation legislation for submission to their respective chambers’ budget committees by May 9. The Energy and Commerce Committee is expected to mark up its bill, with $880 billion in cuts, the week of May 5. The committee is expected to seek nearly $550 billion in cuts to Medicaid spending, with the [...]

joe2025-04-24T14:45:26-04:00April 24, 2025|340b, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid managed care, Medicare, Medicare reimbursement policy|