Policy Updates

Proposed Limits on Medicaid State-Directed Payments Explained

In late May, the Centers for Medicare & Medicaid Services proposed new restraints on state-directed Medicaid payments. In so doing, CMS was seeking to implement a mandate included in H.R. 1, last year’s federal budget reconciliation bill. Since 2016, states have been requiring Medicaid managed care plans to supplement their regular payments to selected Medicaid providers, especially hospitals, as a means of ensuring access to certain medical services in communities where such services are otherwise scarce. States, in turn, have been drawing down federal Medicaid matching funds for those additional payments, increasing federal Medicaid spending. Now, CMS is maintaining that [...]

joe2026-07-07T14:45:49-04:00July 8, 2026|hospitals, Medicaid, Medicaid managed care, Medicaid regulations|

Proposed Medicare Rule Could Hit Hospitals Hard

The Centers for Medicare & Medicaid Services’ proposed 2027 Medicare outpatient prospective payment system rule could pose several serious challenges to hospitals. Among them: A proposed increase of 2.4 percent in payments for outpatient services that could be reduced to only 0.6 percent if CMS adopts its proposal to accelerate its clawback from previous 340B litigation to a three percent reduction. The transition of still more imaging services to site-neutral payments and a prohibition against Medicare outpatient payments for off-campus hospital-based outpatient departments unless each department has its own National Provider Identifier (NPI) and an attestation from the main provider [...]

joe2026-07-07T12:02:42-04:00July 7, 2026|340b, hospitals, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for July 2

Don’t Miss: CMS proposes CY 2027 Medicare outpatient rates, reviving 340B cuts, expanding site-neutral payments CMS calls for modest Medicare home health pay hike, more ways to oust providers Court halts borrowing limit that jeopardized supply of qualified health professionals The following is the latest health policy news from the federal government for June 25-July 2. Some of the language used below is taken directly from government documents. Proposed CY 2027 Medicare Outpatient Prospective Payment and Ambulatory Surgical Center Rule CMS has published its proposed Medicare FY 2027 outpatient and ambulatory surgical center prospective payment system rule. The proposed [...]

joe2026-07-02T16:55:39-04:00July 2, 2026|340b, Accountable Care Organization, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

House Weighs Hospital Transparency Bill

A new bill in the House of Representatives would require most non-profit hospitals to provide more detailed financial information to the federal government to justify their continued tax-exempt status. The Tax Exempt Hospital Transparency Act, currently working its way through the House Ways and Means Committee, would apply, in general, to non-profit hospitals and hospital organizations with more than 100 staffed beds and more than $100 million in patient revenue. Affected tax-exempt hospitals would be required to report annually on how they have addressed the needs identified in their required community needs assessment – and explain why they are not [...]

joe2026-07-01T12:09:31-04:00July 2, 2026|340b, Congress, hospitals|

ACA Marketplace Enrollment Declines

Nearly three million fewer people have enrolled in health insurance plans through the Affordable Care Act Marketplace than last year, according to new federal data. Enrollment in ACA plans so far this year stands at 19.2 million, down nearly three million, or 13 percent, from last year’s high of 22.1. This is the first time overall marketplace enrollment has declined since 2018. While many observers credit this decline to the elimination of enhanced subsidies that helped some people pay their insurance premiums, the administration attributes much of the decline to its success in addressing fraudulent applicants and applications. The reduced [...]

joe2026-06-30T17:05:56-04:00July 1, 2026|Affordable Care Act|

States Sue Feds Over Medicaid Work Requirements

Twenty-five states have sued the federal government in response to the interim final rule published by the Centers for Medicare & Medicaid Services to implement the enhanced work and community engagement requirements for Medicaid eligibility established in H.R. 1, last year’s federal budget reconciliation law. H.R. 1 calls for tougher standards for Medicaid eligibility, including a mandate that most Medicaid participants either work or are engaged in some form of approved community engagement, such as attending school or participating in volunteer work. But the 25 states – all with Democratic governors and attorneys general – claim that CMS’s implementation of [...]

joe2026-06-30T15:49:37-04:00July 1, 2026|Uncategorized|

Federal Health Policy Update for June 25

Don’t Miss: CMS posts a new presentation on Medicaid eligibility under HR 1 House health subcommittee marks up health care price transparency bills Cassidy proposes 340B bill HRSA announces two maternity-related funding opportunities The following is the latest health policy news from the federal government for June 19-25. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee’s Oversight Subcommittee held a hearing to discuss integrity and fraud risk in state Medicaid programs; witnesses included state Medicaid directors from California, Minnesota, New York, and Ohio. For more information, see the press [...]

joe2026-06-25T17:28:47-04:00June 25, 2026|340b, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy|

Remake of Organ Donation Process Continues

The current effort to remake the organ donation process is moving toward a critical juncture. The overhaul, launched more than two years ago as the “Organ Procurement and Transplantation Network Modernization Initiative,” has now moved to the stage where the organizations that facilitate organ donations in the future will be decided. The current plan, which seeks to boost the quantity of donated organs to meet national needs, is to identify and keep the highest performers among the current group of organ procurement organizations, revoke the certification of the weakest of the current performers, and invite organizations to compete for the [...]

joe2026-06-24T12:53:53-04:00June 25, 2026|Uncategorized|

States Finding Rural Transformation Money Comes With Strings

While the Centers for Medicare & Medicaid Services has announced grant awards to states under the Rural Health Transformation program, agency regulators have made it clear that they are prepared to take back some of that money if they do not like how a state’s planning is proceeding. Despite the federal approval of program funding, regulators continue to work with state Medicaid officials to mold their proposed programs to bring them into greater alignment with administration health care objectives. In some cases, states have already modified their plans in response to CMS feedback. According to one published report, CMS administrator [...]

joe2026-06-23T17:28:57-04:00June 24, 2026|Uncategorized|

Future Moms Face Challenge Finding Docs Who Accept Medicaid

The provider directories of Medicaid managed care plans often list maternal providers who do not accept Medicaid patients. At the same time, many of those provider directories list incorrect contact information for their participating maternal health providers. These are among the findings of the U.S. Department of Health and Human Services’ Office of the Inspector General. In two new audit reports, the OIG found that a review of several of the largest Medicaid managed care plans in the country found that anywhere from four to 22 percent of the maternal care providers listed in their provider networks were not actually [...]

joe2026-06-18T16:34:32-04:00June 22, 2026|Medicaid, Medicaid managed care|