Policy Updates

CMS Takes an Axe to the Fax

The days of sending health care claims forms and claims-related documents by fax and regular U.S. mail are fast drawing to a close. Last week the Centers for Medicare & Medicaid Services announced that it will adopt a new regulation – “The Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule” – that will establish HIPAA-compliant standards for sharing health care claims attachments, enabling the secure electronic exchange of health care claims-related supporting clinical documentation and attachments such as medical records, x-rays and imaging, clinical notes, telemedicine visit documentation, and laboratory results. The [...]

joe2026-03-24T13:44:33-04:00March 25, 2026|Uncategorized|

No Surprises Act Activity in 2025

A new Health Affairs report offers a preliminary look at No Surprises Act Independent Dispute Resolution activity for 2025. Among its findings: Providers and facilities initiated 99.9 percent of the disagreements submitted to the IDR process. Four provider groups or representatives of provider groups initiated more than half of those cases. Providers prevailed in 88 percent of the cases. Health plans challenged 40 percent of the cases submitted to the IDR process as ineligible for adjudication under that process. The IDRs upheld their challenges only 17 percent of the time. Health plans are starting to sue those submitting large numbers [...]

joe2026-03-24T16:48:35-04:00March 25, 2026|Uncategorized|

Looking Ahead to New Health Plan Price Transparency Requirements

If the new health plan price transparency requirements proposed by the Centers for Medicare & Medicaid Services are finalized later this year and implemented a year later, as anticipated, they will usher in significant changes in available data for use by consumers, providers, and businesses that collect, analyze, package, and sell such data. The anticipated changes in transparency requirements could include: Specific identification of rate changes from the most recently published rate. Reduced file sizes that eliminate some currently required data and a requirement that health plans post a single in-network file for each provider network instead of a file [...]

joe2026-03-19T17:26:12-04:00March 24, 2026|Uncategorized|

Telehealth May Discourage Low-Value Testing

A new study suggests that greater adoption of telehealth may be accompanied by reduced utilization of low-value medical testing – diagnostic tests, screenings, or procedures that seem to provide little to no clinical benefit to the patient and are increasingly considered unnecessary tests that waste resources despite evidence-based recommendations that they be prescribed less often. The study found that patients served by medical practices that embraced telehealth had slightly more overall visits a year but underwent fewer of seven of the 20 major low-value medical tests, many of which are usually performed at the point of care. The analysis also [...]

joe2026-03-19T16:37:54-04:00March 23, 2026|Telehealth|

Federal Health Policy Update for March 19

The following is the latest health policy news from the federal government for March 13-19. Some of the language used below is taken directly from government documents. The White House President Trump has issued an executive order creating a Task Force to Eliminate Fraud that “…shall, on behalf of the President, coordinate and accelerate a comprehensive national strategy to stop fraud, waste, and abuse within Federal benefit programs, including programs administered jointly with State, local, tribal, and territorial partners.” The vice president will chair the task force, the Secretary of the Department of Health and Human Services is among its [...]

joe2026-03-19T15:41:48-04:00March 19, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare reimbursement policy|

Health Care Workers May Get Relief From New H-1B Visa Fee

A bill newly introduced in the House would provide relief to non-U.S. born health care workers from the $100,000 fee for H-1B visas that was introduced by executive order last year. Under the Physicians and Healthcare Workforce Act, health care workers from other countries would not be required to pay the new $100,000 visa fee to emigrate to and work in the U.S. In introducing the measure, the bill’s bipartisan sponsors noted that the $100,000 visa fee will only exacerbate the current shortage of doctors and other health care workers. Learn more about the bill and its sponsors’ reasons for [...]

joe2026-03-18T12:27:54-04:00March 19, 2026|Congress|

CMS Plans IDR Changes

The Independent Dispute Resolution process that is the central implementation mechanism of the No Surprises Act will soon undergo reengineering. Working with the Labor Department and the Department of the Treasury, the Centers for Medicare & Medicaid Services plans to transition the IDR process from single-use web forms into a new IDR gateway later this year. Previewing a process that it anticipates officially unveiling in the near future, CMS notes that through this new gateway, users be able to start and respond to disputes; gain access to dispute dashboards and reports associated with their organization; track dispute information, including disputes [...]

joe2026-03-17T13:55:25-04:00March 18, 2026|Centers for Medicare & Medicaid Services|

MACPAC Submits March Report to Congress

The Medicaid and CHIP Payment and Access Commission has submitted its mandated March report to Congress. The report consists of four chapters: Chapter 1 offers a recommendation to support the home- and community-based services (HCBS) workforce by requiring states to report hourly wages paid to HCBS workers to help states set effective HCBS payment rates. Chapter 2 focuses on behavioral health in Medicaid and CHIP. Chapter 3 looks at the role of Medicaid in supporting justice-involved youth. Chapter 4 provides an overview of how Medicaid meets the needs of children in child welfare. Learn more from this MACPAC news release, which summarizes the [...]

joe2026-03-17T13:15:26-04:00March 18, 2026|MACPAC, Medicaid, Medicaid long-term services and supports|

MedPAC Submits March Report to Congress

As required by law, the Medicare Payment Advisory Commission has submitted its March report to Congress. In this year’s report, MedPAC: evaluates the adequacy of Medicare’s fee-for-service payments and offers its recommendation for changes in the coming year; offers its perspectives on the Medicare Advantage program (Medicare Part C) and the Medicare prescription drug program (Medicare Part D); describes trends and key issues in post-acute care and offers a status report on ambulatory surgical centers; and submits reports mandated by Congress on the performance of special-needs plans for dually eligible (Medicare and Medicaid) beneficiaries and on how changes in the [...]

joe2026-03-12T17:26:14-04:00March 17, 2026|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. The following is MACPAC’s own summary of its two days of public meetings. MACPAC’s March meeting began with a discussion on the role of automation in the Medicaid prior authorization (PA) process. MACPAC conducted a literature review, a federal policy review, and stakeholder interviews on the role of automation in the PA process. During this session, we reviewed findings and challenges that surfaced in this research, including the extent to which automation is already in use in Medicaid PA; the availability of information and documentation [...]

joe2026-03-12T15:08:27-04:00March 16, 2026|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care|