No Surprises Act

Federal Health Policy Update for November 5

Don’t Miss: CMS releases final 2027 Medicare outpatient rule CMS releases final 2027 Medicare physician fee schedule rule New guidance for batching IDR claims The following is the latest health policy news from the federal government for October 30-November 5. Some of the language used below is taken directly from government documents. 2026 Midterm Elections Democrats regained control of the House and Senate in the 2026 midterm elections. As of 3:30 p.m. eastern time today, the House is 251-155 and the Senate 54-44, both in favor of Democrats, with the outcome of 29 House races and two Senate [...]

joe2026-11-05T17:13:24-05:00November 5, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

What the Changing of the Guard May Bring for Health Care

Medicare for all? A reversal of 2025-enacted cuts in Medicaid eligibility. The restoration of some Affordable Care Act health premium subsidies? More drug price negotiations between the federal government and pharmaceutical companies? The restoration of some National Institutes of Health research funding? A closer look at No Surprises Act dispute adjudication? These are among the policy initiatives that may be undertaken next year in the wake of the outcome of the mid-term elections that saw Democrats gain majorities in both the House and Senate next years? Learn more about some of the policy possibilities for the 120th Congress from [...]

joe2026-11-04T11:01:33-05:00November 4, 2026|Affordable Care Act, Congress, Medicaid, Medicare|

Federal Health Policy Update for October 29

Don’t Miss: CMS charts new path for pursuing ACA premium tax credits CMS publishes timeline for implementation of Medicaid changes Court rejects narrow “medically frail” definition for exemption from Medicaid work requirement Inspector General elaborates on new CMS “power to exclude” The following is the latest health policy news from the federal government for October 23-29. Some of the language used below is taken directly from government documents. Congress The House Committee on Oversight and Government Reform announced an investigation into pharmacy benefit managers (PBMs). In letters to CVS Caremark, Express Scripts, and Optum Rx, Chairman James Comer (R-KY) [...]

joe2026-10-29T17:09:21-04:00October 29, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for October 22

Don’t Miss: Senate Finance Democrats release home care RFI New NIH Women’s Health Division Updated “Health Care Fraud Self-Disclosure” protocol The following is the latest health policy news from the federal government for October 16-22. Some of the language used below is taken directly from government documents. Congress Senate Finance Committee Ranking Member Ron Wyden (D-OR) released a Request for Information (RFI) titled “Delivering An Affordable Home Care Guarantee for American Families,” seeking feedback on policy proposals aimed at making home care affordable and accessible, especially for those with disabilities and seniors; improving the quality of care in nursing homes; [...]

sysadmin2026-10-25T16:53:19-04:00October 22, 2026|340b, Centers for Medicare & Medicaid Services, Congress, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare|

Federal Health Policy Update for October 15

Don’t Miss: IRS proposes changes in rules governing ACA premium tax credits Lawsuit and legislation aim to block 340B Rebate Model Program CMS updates telehealth FAQ The following is the latest health policy news from the federal government for October 9-15. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will reconvene after the mid-term elections on November 9. Upon their return, one of their priorities will be advancing a government funding package because the current continuing resolution (CR) expires on December 11. Affordable Care Act Premium Tax Credits The IRS has [...]

joe2026-10-15T16:58:25-04:00October 15, 2026|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for September 17

Don’t Miss: CMS advises on “medical frailty” as qualification for Medicaid eligibility CMS unveils long-anticipated IDR Gateway Medicare ACCESS Model to expand The following is the latest health policy news from the federal government for September 11-17. Some of the language used below is taken directly from government documents. Congress The House Energy & Commerce Committee’s Health Subcommittee held a hearing to discuss bills seeking to modify certain physician payments under Medicare, to address cybersecurity in the health care system, and to expand seniors’ access to care. See the chairman’s opening statement here and find a list of witnesses [...]

joe2026-09-17T16:23:30-04:00September 17, 2026|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for August 20

Don’t Miss: Latest No Surprises Act/Independent Dispute Resolution news Dept of Homeland Security issues guidance on “public charge” The following is the latest health policy news from the federal government for August 14-20. Some of the language used below is taken directly from government documents. Congress Thirty Senate Democrats have written to HHS Secretary Kennedy seeking to reverse the cancellation of health research grants administered by the Agency for Healthcare Research and Quality (AHRQ). For more information, see the letter here. Congress remains in recess; the House is expected to return on August 31 and the Senate on September 14. [...]

joe2026-08-20T15:55:42-04:00August 20, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Court Rejects No Surprises Act’s QPA Methodology

A federal appeals court has rejected how health care payers calculate their qualifying payment amount, or QPA, when addressing disputed payments under the No Surprises Act’s Independent Dispute Resolution process. The QPA is the central benchmark rate payers present to help settle out-of-network medical billing disagreements that for years led to surprise medical bills for many hospital patients. The court concluded that payers should not be permitted to include so-called ghost rates when calculating their QPA; a ghost rate is a rate for services that a given provider does not actually provide, leaving the provider no incentive to attempt to [...]

joe2026-08-13T15:13:04-04:00August 14, 2026|Uncategorized|

Federal Health Policy Update for August 13

Don’t Miss: Federal court vacates key aspect of No Surprises Act’s IDR process President calls for changes in childhood immunizations CMS seeks billing info so it can pay APM docs their bonuses The following is the latest health policy news from the federal government for August 7-13. Some of the language used below is taken directly from government documents. The White House The White House has issued an executive order calling for a change in recommended childhood vaccines. The order suggests reducing the number of recommended childhood vaccines from the current 17 to 11 revising the status of the remaining [...]

joe2026-08-13T14:39:23-04:00August 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

CMS Clarifies Upcoming IDR Changes

Earlier this year, the departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management published federal Independent Dispute Resolution operations final rules to improve the functioning of the No Surprises Act’s IDR process, which is part of a broader effort to eliminate surprise medical bills. The new rules seek to streamline communication between health care payers, providers, and certified IDR entities by establishing new timelines and processes. When the individual requirements in these final rules will take effect will vary depending on when the technical capacity to support them is ready within the not-yet-introduced [...]

joe2026-08-12T13:05:25-04:00August 13, 2026|Uncategorized|