Medicaid state directed payments

Federal Health Policy Update for May 8

The following is the latest health policy news from the federal government for May 2-8. Some of the language used below is taken directly from government documents. Congress Reconciliation Over the past several days the political gravity surrounding Medicaid cuts has begun to shift slightly. Moderate Republicans have been pushing back more forcefully and more loudly against such cuts, with some saying they will not support more than work requirements and increased enforcement checks for eligibility. Opposition to most Medicaid cuts led the Energy and Commerce Committee to delay a markup of its reconciliation bill planned for this week to [...]

joe2025-05-08T16:50:48-04:00May 8, 2025|Accountable Care Organization, Alternative payment models, Congress, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|

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|

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|

Hospitals Chart 2025 Public Policy Objectives

The hospital industry has an ambitious public policy agenda for 2025 – most of it involving defending the status quo against proposed changes. Hospitals’ advocacy in 2025 will focus on: Fighting off Medicaid cuts, work requirements, reductions in the federal Medicaid matching rate, eliminating scheduled cuts in Medicaid disproportionate share (Medicaid DSH) allotments to the states, and protecting state-directed Medicaid payments and the ability of states to raise Medicaid funding through provider taxes. Preventing a transition to site-neutral payments for Medicare-covered outpatient services. Ensuring the continuation of current section 340B prescription drug discount program practices. Preserving and even extending current [...]

joe2025-02-12T11:11:23-05:00February 13, 2025|340b, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy, Telehealth|

MACPAC Looks at Medicaid State Directed Payments

In 2016, the Centers for Medicare & Medicaid Services authorized states to direct Medicaid managed care organizations to pay providers according to specific rates or methods. Typically, states use these arrangements, often referred to as state directed payments, to establish minimum payments for certain types of providers or to require participation in value-based payment arrangements. A few states, though, use state directed payments to require Medicaid managed care organizations to make large, additional payments to providers similar to supplemental payments their Medicaid fee-for-service programs. In a new issue brief, the Medicaid and CHIP Payment and Access Commission describes the history [...]

iqtsupport2023-07-05T13:34:25-04:00July 5, 2023|Centers for Medicare & Medicaid Services, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care|

Federal Health Policy Update for June 29

The following is the latest health policy news from the federal government for June 23-29. Some of the language used below is taken directly from government documents. The White House President Biden has issued an executive order on strengthening access to affordable contraception and family planning services for women with private health insurance and through Medicaid, Medicare, and federally supported health programs and to foster research on access. Learn more from this White House fact sheet and the administration’s executive order. Department of Health and Human Services HHS’s Office of the Inspector General (OIG) has posted its final rule [...]

iqtsupport2023-06-29T15:36:39-04:00June 29, 2023|Affordable Care Act, 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, Medicare reimbursement policy|