Policy Updates

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|

Sneak Peek at HHS Budget Reveals Reorganization, Cuts

A big-picture document summarizing the Trump administration’s intentions for the Department of Health and Human Services suggests the agency is in for a major round of cuts and reorganization, some of which is already underway. Among the cuts noted in the 64-page document are a $20 billion cut (40 percent) in the National Institutes of Health budget; a $4 billion cut (44 percent) in the budget of the Centers for Disease Control and Prevention that would eliminate the agency’s work on chronic disease programs; the elimination of a number of rural health programs; and the elimination of all funding for [...]

joe2025-04-22T15:14:40-04:00April 23, 2025|Uncategorized|

Federal Health Policy Update for April 17

The following is the latest health policy news from the federal government for April 11-17. Some of the language used below is taken directly from government documents. The White House President Trump signed an executive order titled “Lowering Drug Prices by Once Again Putting Americans First” that directs the Secretary of the Department of Health and Human Services to take steps to lower prescription drug costs for patients. The order addresses several prescription drug-related policies, including: the Medicare Drug Price Negotiation Program seeking better Medicare prices for drugs not subject to the Medicare Drug Price Negotiation Program accelerating FDA drug [...]

joe2025-04-17T17:14:31-04:00April 17, 2025|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy|

States Scramble to Fill Potential Health Insurance Gap

With the clock ticking on the deadline for Congress to renew enhanced subsidies for Affordable Care Act marketplace health insurance, a number of states are looking for ways to compensate for the loss of that subsidy money and help some of their residents remain insured. California, Colorado, Maryland, and Washington are among the states looking in their pockets and underneath the sofa cushions in search for money to replace federal insurance premium subsidy money they fear will disappear at the end of 2025. They are doing so, moreover, at a time when Congress is looking hard at significant reductions in [...]

joe2025-04-10T17:11:40-04:00April 14, 2025|Affordable Care Act, Medicaid|

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 today passed the budget resolution passed by the Senate last week. Passage of the same budget resolution by both chambers now enables Congress to begin work on a reconciliation bill to enact President Trump’s priorities on tax cuts, border security, and energy policies. Until this morning, more than a dozen Republican House members had opposed the Senate-passed budget resolution because they believed the Senate’s budget did not require enough spending [...]

joe2025-04-10T16:05:02-04:00April 10, 2025|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|