Policy Updates

MedPAC Reports to Congress

The Medicare Payment Advisory Commission has issued its annual report to Congress. This year’s report examines: how Medicare payment incentives affect federal spending and the delivery of care and how those incentives can be improved the challenges beneficiaries encounter when deciding on their enrollment in Medicare how Medicare identifies improper payments – and how it can do so more effectively the association between enrollment in Medicare Advantage plans and provider finances access to selected palliative care services under Medicare’s hospice benefit MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding [...]

joe2026-06-16T16:58:28-04:00June 17, 2026|hospitals, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for June 11

The following is the latest health policy news from the federal government for June 5-11. Some of the language used below is taken directly from government documents. Don’t Miss: CMS warns more than 500 hospitals for failing to meet price transparency requirements HHS OIG looks at Medicare Advantage rejections of post-acute services Federal court rejects $100,000 H-1B visa fee HHS RFI seeks new approaches, including AI, for treating addiction CMS creates new office to help with tech modernization Congress Some Republican members of Congress continue to plan for a third party-line reconciliation bill to focus on health care affordability. The [...]

joe2026-06-11T16:08:27-04:00June 11, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Marketplace Enrollment Declines

With the elimination of enhanced premium tax credits, enrollment in Affordable Care Act health insurance exchange plans is falling. Last year saw 24 million people enroll in ACA marketplace plans – an all-time high. 2026 enrollment, though, is down 1.2 million, or five percent – the largest year-to-year decline since the exchanges started offering health insurance in 2014. Overall, enrollment has fallen in 41 states, with those declines ranging from one to 22 percent. In addition, 14 percent of those who signed up for plans in 2026, or who were automatically reenrolled because of past enrollment, did not pay their [...]

joe2026-06-10T11:43:01-04:00June 11, 2026|Affordable Care Act|

CMS Warns Hospitals About Price Transparency

The Centers for Medicare & Medicaid Services has written to more than 500 hospitals, warning them that they are failing to meet federal requirements for price transparency. The letter warns hospitals that they are at risk of fines if they do not publicly provide more and better price information. Some have been told they must submit improvement plans. CMS’s view is that the lack of price transparency prevents consumers from comparing hospitals’ prices for services. Learn more about the CMS warning and find a link to a list of the hospitals that have been warned in the AP article “Trump [...]

joe2026-06-09T17:20:07-04:00June 10, 2026|Centers for Medicare & Medicaid Services, hospitals|

CMS Defines “Medical Frailty” for Medicaid Eligibility Purposes

With the federal government about to implement a work/community engagement requirement for eligibility for Medicaid coverage, regulators have attempted to define what constitutes “medical frailty” as a reason for exemption from that requirement. In a new report, KFF explains that a newly adopted rule presenting the Medicaid work/community engagement requirement employs “… a restrictive definition of medical frailty that differs from states’ early expectations” and ties “… medical frailty specifically to the ability to comply with the community engagement requirement (i.e., the ability to work) and prohibiting states from adding categories of individuals to the medical frailty definition.” KFF also [...]

joe2026-06-04T17:20:17-04:00June 8, 2026|Medicaid|

Federal Health Policy Update for June 4

Don’t miss: CMS publishes new Medicaid work/community engagement requirements Energy and Commerce Committee looks at price transparency in health care An AI executive order and Congress prepares to weigh in Price cut: IDR dispute fee to fall from $115 to $15 per dispute The following is the latest health policy news from the federal government for May 29 to June 4. Some of the language used below is taken directly from government documents. Medicaid Work Requirements – Interim Final Rule CMS has published an interim final rule with comment period to implement the Medicaid work and community engagement requirements [...]

joe2026-06-04T16:30:46-04:00June 4, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare|

A 340B Scorecard

Hospitals suing CVS Health over 340B savings. The Health Resources and Services Administration’s proposed 340B Rebate Model Pilot Program. Eli Lilly’s demand that hospitals share claims-level data for 340B-covered drugs. The continuing battle over the involvement of contract pharmacies in providing access to 340B-covered drugs. Sometimes it seems as if barely a week passes without some new challenge to the 340B program. In a recent article, Becker’s Hospital News presents an update on the latest in challenges to the 340B program. Learn more from its article “340B in 2026: Tracking litigation, mandates and policy shifts reshaping the program.”

joe2026-06-03T12:31:11-04:00June 4, 2026|340b|

CMS Proposes New Medicaid Eligibility Requirements

The Centers for Medicare & Medicaid Services has published an interim final rule implementing the Medicaid work/community engagement requirements mandated by H.R. 1, last year’s federal budget reconciliation bill. The rule defines community engagement requirements for adults to gain or maintain Medicaid eligibility for applications on or after January 1, 2027. Under the rule, individuals will be eligible for Medicaid if they participate in 80 hours of employment, community service, work programs, or other qualifying activities. Under this interim final rule, states must: identify who is subject to or exempt from the work requirements verify compliance at application and renewal [...]

joe2026-06-03T08:06:29-04:00June 3, 2026|Medicaid|

Federal Health Policy Update for May 28

The following is the latest health policy news from the federal government for May 22-28. Some of the language used below is taken directly from government documents. Congress When Congress returns from the Memorial Day recess next week, lawmakers will have to address the Republican-led reconciliation bill to fund ICE and CBP. After, they plan to start working on a third party-line bill focusing on affordability—including health care—which leadership aims to pass by the end of July. Next week, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies is scheduled to mark up its Fiscal [...]

sysadmin2026-05-28T17:43:32-04:00May 28, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicare, Medicare regulations, Medicare reimbursement policy|

HHS Advisory Committee Holds First Meeting

An advisory panel created by the Department of Health and Human Services to advise the agency on how to improve the financing and delivery of health care by Medicare, Medicaid, and the Children’s Health Insurance Program and through the health insurance marketplace held its first public meeting earlier this week. HHS’s Healthcare Advisory Committee, which consists of 15 members, discussed its bylaws and heard presentations from the leaders of its six workgroups. Those workgroups are: Reducing Administrative Burden MAHA by Improving Wellness and Preventing Chronic Disease Deploying Real-Time Data Improving Care for Vulnerable Populations Strengthening Medicare Advantage Crushing Fraud, Waste, [...]

joe2026-05-20T09:26:01-04:00May 22, 2026|Medicaid, Medicare|