Putting Some Meat on CMS’s WISeR Bones
In June, the Centers for Medicare & Medicaid Services announced a new CMS Innovation Center model: The Wasteful and Inappropriate Service Reduction Model, or WISeR. The idea behind WISeR is for Medicare to seek to reduce waste, fraud, and abuse [...]
The Likelihood of Major Medicare Cuts
While the potential for significant Medicaid cuts resulting from passage of the FY 2025 federal budget reconciliation bill – the so-called One Big Beautiful Bill – has received a great detail of attention, the possibility of Medicare cuts as well [...]
Survey Looks at Prior Authorization in Medicaid
A recently published study takes a closer look at the state of prior authorization practices in state Medicaid managed care programs. The survey explored prior authorization decision time frames, the use of electronic denial notices, patient access to external medical [...]
Federal Health Policy Update for August 14
The following is the latest health policy news from the federal government for August 8-14. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess and will return to [...]
Potential Medicaid Implications of the “One Big Beautiful Act”
Growing uncompensated care. Service cuts. Reduced access to care, especially in rural areas. Expansion projects placed on hold. These are among the potential implications of the Medicaid cuts included in the recently passed FY 2025 budget reconciliation bill, often referred [...]
Changes Coming to 340B?
The 340B prescription drug pricing program, created more than 30 years ago to help low-income outpatients receive discounted prescription drugs, has long been a source of controversy – and the subject of a number of lawsuits in recent years. Now, [...]
Coming Soon: The Rural Health Transformation Program
Federal health care officials are getting ready to bring the FY 2025 budget reconciliation bill’s “Rural Health Transformation Program” to life. Added to the “One Big Beautiful Bill” to provide assistance to rural hospitals that maintained that their existence would [...]
Federal Health Policy Update for August 7
The following is the latest health policy news from the federal government for August 2-7. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess. When Congress returns in [...]
The Coming Medicaid Work Requirement
Among the many Medicaid-related aspects of the recently enacted FY 2026 budget reconciliation bill – the One Big Beautiful Bill Act – is a new requirement that much of the Medicaid population be employed or participate in some acceptable form [...]
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. [...]
