CMS Sets Final ACA Terms for 2027
The Centers for Medicare & Medicaid Services has issued its annual “Notice of Benefit and Payment Parameters for 2027; Basic Health Program,” which governs health plans offered through the federal health insurance exchange and state exchanges as established under the [...]
MACPAC Seeks Guardrails for AI Use in Medicaid Prior Authorization
While acknowledging the potential value of the use of AI in facilitating Medicaid prior authorization decisions, the agency that advises Congress on Medicaid and Children’s Health Insurance Program policy will recommend to Congress that the programs erect guardrails to protect [...]
Federal Health Policy Update for May 14
The following is the latest health policy news from the federal government for May 8-14. Some of the language used below is taken directly from government documents. Congress The Ways and Means Committee has circulated a discussion draft of a [...]
A Closer Look at the Proposed Drug Prior Authorization Regulation
Last month, the Centers for Medicare & Medicaid Services proposed new requirements for the prior authorization of drugs for patients served by Medicare Advantage, Medicaid, CHIP, and qualified health plans in the federal marketplace. This proposal represented a next step [...]
MACPAC Meets
Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. During the course of the deliberations, MACPAC’s staff made the following presentations to the commissioners: Automation in Medicaid Prior Authorization: Recommendations Exploring the Role [...]
Hospital at Home Proving its Worth?
A new study suggests that hospital at home programs are producing positive results for patients and the health care system. Positive results such as greater comfort for patients, fewer returns to the hospital emergency department within 30 days of discharge, [...]
The Latest CMS Efforts on Prior Authorization
The Centers for Medicare & Medicaid Services continues to work tackling the challenges posed by health insurers that insist they will not pay for certain medical services unless they authorize those services beforehand. In a new blog post, CMS Administrator [...]
Federal Health Policy Update for May 7
The following is the latest health policy news from the federal government for May 1-7. Some of the language used below is taken directly from government documents. Congress Congress hopes to pass a reconciliation package to fund Immigration and Customs [...]
States Continue to Prep for Medicaid Eligibility Changes
With last year’s budget reconciliation bill – also known as H.R. 1 and the “Big Beautiful Bill Act” – requiring most Medicaid beneficiaries to have jobs or participate in community engagement activities beginning next year, the states continue to develop [...]
HHS to Attack Overprescribing of Psychiatric Drugs
The Department of Health and Human Services is launching a campaign to reduce the frequency with which providers prescribe drugs for patients with behavioral health challenges. The new campaign, announced earlier this week, will seek to analyze prescribing patterns for [...]
