Policy Updates

Federal Health Policy Update for July 31

The following is the latest health policy news from the federal government for July 25-31. Some of the language used below is taken directly from government documents. Congress The House recessed last week and the Senate is still in session. When Congress returns in September its top priority will be funding the federal government before the fiscal year ends on September 30, likely requiring a continuing resolution to avoid a shutdown. Several major health care programs and extenders are set to expire at the end of the fiscal year, including Medicaid DSH allotments, telehealth flexibilities, the Acute Hospital Care at [...]

joe2025-07-31T15:04:29-04:00July 31, 2025|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare reimbursement policy, Telehealth|

Providers Dominating No Surprise Act Dispute Resolution

Health care providers are winning the vast majority of payment disputes resolved under the No Surprises Act’s Independent Dispute Resolution process. Contrary to the expectation that the number of cases the process would adjudicate would decline once payers and providers got a better sense of what kinds of cases were being disputed and their outcome, the number of cases going into the process has only grown – considerably. And so has providers’ success rates. Providers won 70 percent of the disputes during the first quarter of 2023 and that rate rose to 87 percent by the fourth quarter of that [...]

joe2025-07-29T17:20:29-04:00July 30, 2025|Uncategorized|

Federal Health Policy Update for July 24

The following is the latest health policy news from the federal government for July 18-24. Some of the language used below is taken directly from government documents. The White House The White House has released its AI action plan. Winning the Race: America’s AI Action Plan is a 28-page document that mentions health care only in passing but includes provisions that could potentially affect the health care industry. Find the plan here. Congress The House has adjourned for recess and will return to Washington after Labor Day. The Senate remains in session, expecting to recess next week. When Congress returns [...]

joe2025-07-24T15:08:24-04:00July 24, 2025|Centers for Medicare & Medicaid Services, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicare, Medicare post-acute care, Medicare reimbursement policy, post-acute care, Telehealth|

CMS Pulling the Plug on Continuous Medicaid Eligibility

Continuous eligibility for Medicaid is being phased out, the Centers for Medicare & Medicaid Services has announced. Characterizing its decision as one that follows more closely the statutory underpinnings of Medicaid and the Children’s Health Insurance Program, CMS explains that it “… is issuing guidance to states making clear it does not anticipate approving new or extending existing section 1115 demonstration authorities that have allowed some individuals to remain enrolled in Medicaid or CHIP for extended periods of time, even if they may not have otherwise been eligible.” At the same time, CMS announced that it is taking a similar [...]

joe2025-07-23T11:53:54-04:00July 24, 2025|Centers for Medicare & Medicaid Services, Medicaid|

The New Rural Health Fund

Recognizing that the Medicaid and other health care cuts in the recently enacted FY 2026 budget reconciliation bill – the so-called One Big Beautiful Bill – will exact a heavy toll on rural hospitals, Congress included in that bill a short-term Rural Health Fund designed to help ameliorate the impact of some of the cuts it was adopting. KFF Health has taken a closer look at the Rural Health Fund, how it is structured, and how it is expected to work and has identified some of the bill’s major components. They include: The rural health fund includes $50 billion, which [...]

joe2025-07-23T10:30:29-04:00July 23, 2025|Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid|

OBBB Implementation Timeline

DeBrunner & Associates has prepared a timeline presenting the timeline showing the stages through which the FY 2026 federal budget reconciliation bill (the “One Big Beautiful Bill”) will be implemented. Find it here.

joe2025-07-17T15:53:25-04:00July 21, 2025|Congress, Medicaid, Medicaid regulations, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for July 17

The following is the latest health policy news from the federal government for July 11-17. Some of the language used below is taken directly from government documents. Proposed Medicare Outpatient Prospective Payment and Ambulatory Surgical Center Payment System Regulation for CY 2026 CMS has published its proposed Medicare outpatient prospective payment and ambulatory surgical center payment system rule for CY 2026. Highlights include: A 2.4 percent increase in outpatient rates that is offset by a two percentage point clawback under the 340B final remedy rule, making the actual increase just 0.5 percent. A site-neutral payment policy for the outpatient administration [...]

joe2025-07-17T14:50:40-04:00July 17, 2025|340b, Accountable Care Organization, ACO, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care, social determinants of health, Telehealth|

Hospitals Shedding OB Services

Hospitals are closing down their obstetric services at an alarming rate – especially rural hospitals. According to a recent study: In eight states, more than two-thirds of rural hospitals do not offer OB services. In 2022, the majority of rural hospitals in three states – North Dakota, Oklahoma, and West Virginia – did not offer OB services. More than 40 percent of rural hospitals ended their OB services between 2010 and 2022 in Pennsylvania, South Carolina, West Virginia, and Florida. Between 2010 and 2022, only three states – Delaware, Utah, and Vermont – saw no termination of OB programs. During [...]

joe2025-07-10T15:10:54-04:00July 14, 2025|Uncategorized|

Federal Health Policy Update for July 10

The following is the latest health policy news from the federal government for July 4-10. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has posted an FAQ on inpatient hospital reviews with an emphasis on short hospital stays and its MAC Targeted Probe and Educate (TPE) program. Find that FAQ here. Department of Health and Human Services HHS has rescinded a 1998 interpretation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) that extended certain federal public health care benefits to illegal residents. Among the health [...]

joe2025-07-10T15:25:22-04:00July 10, 2025|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicare|

States Mull Response to Reconciliation Bill’s Medicaid Cuts

Establishing new grant programs for hospitals, especially for rural hospitals. Reducing or eliminating optional Medicaid benefits such as dental and vision. Cutting payments to providers. Calling their legislature back into session. These are among the moves states are considering in the wake of passage of the FY 2026 budget reconciliation bill that results in hospitals facing a loss of approximately 18 percent of their Medicaid funding over the next decade. Learn more about some the Medicaid financial challenges states now face and how they are considering responding to them in the Stateline article “States scramble to shield hospitals from GOP [...]

joe2025-07-08T11:54:16-04:00July 9, 2025|Medicaid|