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All posts tagged with “Regulatory News | Medicaid.”
CMS halts spending for nonmedical in-home Medicaid services, likely affecting providers
04/16/25 at 03:00 AMCMS halts spending for nonmedical in-home Medicaid services, likely affecting providers McKnights Home Care; by Adam Healy; 4/13/25 The Centers for Medicare & Medicaid Services told states last week that it would not approve future federal matching funds for designated state health programs (DSHPs) and designated state investment programs (DSIPs). These programs are widely used to help Medicaid beneficiaries remain at home and in their communities.
Community Catalyst leads national response against new rule that threatens health care access
04/15/25 at 03:00 AMCommunity Catalyst leads national response against new rule that threatens health care access Community Catalyst, Boston, MA; by Jack Cardinal; 4/11/25 Today, Community Catalyst organized hundreds of local, state and national partners to submit comments to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) opposing a new proposed rule from the Trump administration that would make it harder and more expensive for people to buy their own insurance on Affordable Care Act (ACA) Marketplaces and increase their medical debt. ... The administration’s own estimates suggest that as many as 2 million people will lose their coverage under this proposal, ...
Closing the gap in end-of life care coverage: The role of nonprofits in policy advocacy
04/15/25 at 03:00 AMClosing the gap in end-of life care coverage: The role of nonprofits in policy advocacy Forbes; by James Dismond; 4/14/25... As the demand for end-of-life care grows, so will the gap between the care that patients need and what they receive. ... Workforce shortages, restrictive regulations, outdated reimbursement models and misconceptions around hospice services are keeping millions of Americans from accessing quality hospice and palliative care services. ... These barriers disproportionately affect low-income families, rural communities and communities of color. ... Unlike for-profit entities, we can prioritize community needs over shareholders. We can prioritize patient well-being over profits—or, to say it more directly, we put people over profits. And I’ve seen firsthand how advocacy can drive progress. Nonprofits must engage in:
CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid Partnership
04/15/25 at 03:00 AMCMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid PartnershipCMS press release; 4/11/25The Centers for Medicare & Medicaid Services (CMS) is taking action to preserve the core mission of the Medicaid program by putting an end to spending that duplicates resources available through other federal and state programs or isn’t directly tied to healthcare services. Mounting expenditures, such as covering housekeeping for individuals who are not eligible for Medicaid or high-speed internet for rural healthcare providers, distracts from the core mission of Medicaid, and in some instances, serves as an overly-creative financing mechanism to skirt state budget responsibilities.
National Alliance for Care at Home responds to the FY 2026 Hospice Proposed Rule
04/15/25 at 02:00 AMNational Alliance for Care at Home responds to the FY 2026 Hospice Proposed Rule National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 4/11/25 The National Alliance for Care at Home (the Alliance) issued the following statement [Fri 4/11] in response to the Centers for Medicare & Medicaid Services (CMS) Fiscal Year (FY) 2026 Hospice Wage Index proposed rule, which proposes payment and regulatory updates under the Medicare hospice benefit. The proposed 2.4% payment update fails to adequately address the mounting financial pressures facing hospices nationwide. With escalating operational costs driven by inflation, workforce shortages, and rising expenses for supplies and services, the proposed payment increase would threaten the ability of hospices to sustainably provide quality end-of-life care. “The proposed payment update for FY 2026 falls short of what is needed to sustain high-quality hospice care,” said Dr. Steve Landers, CEO of the Alliance. “Without meaningful adjustments, hospices across the country will face serious challenges—jeopardizing access to care for terminally ill patients and placing added strain on families already facing the unimaginable. ..."
CMS drops 5 proposed payment rules for 2026: 25 things to know
04/15/25 at 02:00 AMCMS drops 5 proposed payment rules for 2026: 25 things to knowBecker's Hospital Review; by Alan Condon; 4/11/25 CMS has released proposed payment rules for inpatient and long-term care hospitals, hospices and inpatient rehabilitation, psychiatric and skilled nursing facilities in fiscal year 2026. Twenty-five things to know: ...
Dr. Oz outlines vision for CMS: 8 notes
04/14/25 at 03:00 AMDr. Oz outlines vision for CMS: 8 notesBecker's Hospital Review; by Jakob Emerson; 4/10/25CMS Administrator Mehmet Oz, MD, said April 10 that his vision for the agency includes a commitment to President Trump’s “Make America Healthy Again” agenda and modernizing Medicare, Medicaid and the ACA marketplace. Eight notes:
Medicare and Medicaid officials finalize rule to clarify that medical marijuana isn’t covered by federal health programs
04/10/25 at 03:00 AMMedicare and Medicaid officials finalize rule to clarify that medical marijuana isn’t covered by federal health programsMarijuana Moment; by Kyle Jaeger; 4/8/25 The federal Centers for Medicare & Medicaid Services (CMS) has finalized a rule to clarify that marijuana products are not eligible for coverage under certain health plans for chronically ill patients because “they are illegal substances under Federal law.” In a notice set to be published in the Federal Register next week, CMS said that a series of policy and technical changes for its Medicare Advantage (MA) program and other services, including rulemaking related to cannabis products, will now take effect on June 3.[Continue reading ...]
Trump administration continues to defend nursing home staffing mandate in court
04/08/25 at 03:00 AMTrump administration continues to defend nursing home staffing mandate in court McKnights Long-Term Care News; by Kimberly Marselas; 4/7/25 The federal government continues to defend a national nursing home staffing mandate in court, despite several members of the new presidential administration having expressed major concerns about the rule finalized in 2024. Department of Justice attorneys on Thursday again outlined their justification for the rule, telling the Eighth Circuit Court of Appeals that the Centers for Medicare & Medicaid Services did not exceed its legal authority in dictating 24-hour registered nurse coverage and 3.48 hours a day of direct patient care from every US skilled nursing facility.
AGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers
04/07/25 at 03:00 AMAGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers JD Supra; by Arnall Golden Gregory, LLP; 4/3/25 In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.
New administration’s appointees confirmed to lead key health agencies
04/07/25 at 03:00 AMNew administration’s appointees confirmed to lead key health agencies Association for Clinical Oncology (ASCO); Press Release; 4/3/25 Several presidential appointees have been confirmed to lead key health agencies that the Association for Clinical Oncology (ASCO) will work with during the new administration. These include:
Senate confirms Oz as head of agency that runs Medicare, Medicaid
04/04/25 at 03:00 AMDr. Oz nomination to lead CMS advances in Senate vote Modern Healthcare; by Michael McAuliff; 4/3/25 The Senate on Thursday advanced the confirmation of former television host Dr. Mehmet Oz to lead the nation's largest healthcare agencies by serving as administrator of the Centers for Medicare and Medicaid Services. Lawmakers voted 50 to 45 to advance the nomination to a final vote, which is expected Thursday afternoon. ... He will assume control of an agency in flux that impacts some 160 million Americans and with a budget of around $1.7 trillion. Health Secretary Robert F. Kennedy Jr. is attempting to cut some 20,000 employees across the the Health and Human Services Department while Congress is weighing budget proposals that are likely to require deep cuts in Medicaid. [Continue reading ...]
HHS restructures duals, PACE offices amid department overhaul
04/04/25 at 03:00 AMHHS restructures duals, PACE offices amid department overhaul Modern Healthcare; by Bridget Early; 4/3/25 The Health and Human Services Department is reorganizing a handful of key programs for dually eligible enrollees and older adults, including laying off numerous staffers. HHS is shuffling how it manages care coordination for people dually eligible for Medicare and Medicaid under the Medicare-Medicaid Coordination Office and the Program of All-Inclusive Care for the Elderly. PACE, which had been poised for growth, offers home and center-based care mostly to dual-eligible Medicare and Medicaid enrollees who qualify for skilled nursing but can still live in their communities. A spokesperson for HHS said the department has “planned productivity enhancements for the PACE management department.” HHS did not elaborate on what management changes for the PACE program might look like.
Trump administration to shut down CMS, HHS minority health offices amid restructuring
04/04/25 at 03:00 AMTrump administration to shut down CMS, HHS minority health offices amid restructuring Healthcare Dive; by Rebecca Pifer; 3/31/25 The CMS and HHS offices that coordinate efforts to eliminate health disparities are being shut down completely as part of the Trump administration’s overhaul of the federal healthcare department, according to sources with direct knowledge of the matter. Closing the offices will impact efforts to improve the health of underserved patients in the U.S. — and is probably illegal, according to experts. ... Shutting the offices, which were authorized by the Affordable Care Act more than a decade ago, may also be illegal, according to legal experts. [Continue reading ...]
Health system CFOs fight for Medicaid on Capitol Hill
04/02/25 at 03:00 AMHealth system CFOs fight for Medicaid on Capitol Hill Becker's Hospital Reivew; by Alan Condon; 3/31/25 Multiple health system CFOs recently traveled to Washington, D.C., to meet with lawmakers on Capitol Hill, advocating against proposed Medicaid cuts that could threaten access to care and lead to the closure of essential hospital services. Health system executives participating in these discussions included:
Mass layoffs hit workers at HHS; sweeping cuts extend to CDC, NIH, FDA: Recap
04/02/25 at 03:00 AMMass layoffs hit workers at HHS; sweeping cuts extend to CDC, NIH, FDA: Recap USA Today; by Sarah D. Wire, Josh Meyer, Bart Jansen, Ken Alltucker, Cybele Mayes-Osterman, Eduardo Cuevas, Sudiksha Kochi, Adrianna Rodriguez and Terry Collins; 4/1/25Mass layoffs began Tuesday at the Centers for Disease Control and Prevention and at the Food and Drug Administration, the first steps in a plan to cut 10,000 jobs at the Department of Health and Human Services. The department responsible for overseeing protection for Americans' health, food and drug supplies and Medicare and Medicaid is also closing its internal agencies that are focused on older adults and people with disabilities. It's also getting rid of its offices tackling HIV and improving minority health. Staff had to present their badges at the building entrance and those who had been fired were given a ticket and told to return home. More than 100,000 federal workers have already lost their jobs in the last two months as part of President Donald Trump and billionaire Elon Musk's efforts to shrink staffing levels in federal departments and agencies. Tens of thousands more are expected as more agencies implement their reduction in force, or RIF, plans in the coming weeks.
Medicare Administrative Contractors [MACs] did not consistently meet Medicare Cost Report Oversight Requirements
04/02/25 at 03:00 AMMedicare Administrative Contractors [MACs] did not consistently meet Medicare Cost Report Oversight Requirements HHS-OIG; Issued on 3/18/25, posted on 3/19/25 ... What OIG Found: MACs did not consistently meet Medicare cost report oversight requirements.
Walgreens settles Illinois Medicaid fraud lawsuit for $5M
04/02/25 at 03:00 AMWalgreens settles Illinois Medicaid fraud lawsuit for $5M Modern Healthcare; by Katherine Davis; 3/25/25 Walgreens Boots Alliance will pay $5 million to settle allegations that it violated U.S. and Illinois false claims statutes by improperly billing Medicaid and Medicare. The settlement, disclosed in court filings [3/24], marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement, disclosed in court filings yesterday, marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement funds will be divided among the U.S. government, the state of Illinois and the whistleblowers, according to court filings. All parties also filed a joint stipulation of dismissal yesterday. Walgreens declined to comment. [Continue reading; access to the full article may be limited to subscription ...]
Evaluation of the Medicare Advantage Value-Based Insurance Design model test: 2020 to 2023
03/31/25 at 02:00 AMEvaluation of the Medicare Advantage Value-Based Insurance Design model test: 2020 to 2023 RAND Health Care, prepared for the Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation Under Research, Measurement, Assessment, Design, and Analysis Contract Number 75FCMC19D0093, Order Number 75FCMC20F0001; by Christine Eibner, Dmitry Khodyakov, Erin A. Taylor, Denis Agniel, Rebecca Anhang Price, Julia Bandini, Marika Booth, Lane F. Burgette, Christine Buttorff, Catherine C. Cohen, Stephanie Dellva, Michael Dworsky, Natalie C. Ernecoff, Alice Y. Kim, Julie Lai, Monique Martineau, Nabeel Qureshi, Afshin Rastegar, Max Rubinstein, Daniel Schwam, Joan M. Teno, Anagha Tolpadi, Shiyuan Zhang; March 2025 This report presents RAND researchers’ findings from their evaluation of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model test for 2020 through 2023, initiated by the Center for Medicare and Medicaid Innovation (Innovation Center). The VBID Model allows participating MA parent organizations (POs) to offer supplemental benefits, financial and nonfinancial incentives to beneficiaries, hospice benefits (the Medicare Hospice Benefit, Palliative Care, Transitional Concurrent Care, and Hospice Supplemental Benefits), and Wellness and Health Care Planning through their MA plans.
Population-based payments to deliver health care to unhoused individuals
03/29/25 at 03:05 AMPopulation-based payments to deliver health care to unhoused individualsJAMA Health Forum; Sudhakar V. Nuti, MD, MSc; Amanda K. Johnson, MD, MBA; Theodore Long, MD, MHS; 3/25The 770,000 people experiencing homelessness in the US have a high prevalence of disease and high health care utilization. Compared to the general population, unhoused individuals in the US have a 3.5 times higher mortality rate and 27-year reduced life expectancy. To this end, we propose population-based payment models (PBPs) as a novel mechanism to provide increased, stable, and predictable funding for health care for unhoused individuals. PBPs are the most advanced category of value-based alternative payment models, where health care organizations are given a prospective payment to care for a population of patients, with the flexibility to tailor care without incentivizes to optimize billable encounters, while being held accountable for improved outcomes and costs. The flexibility in how to invest and earn funding is essential for focused investment in these models, as increased reimbursement alone is insufficient.
Kennedy slashing 10,000 jobs in health department overhaul
03/28/25 at 03:00 AMKennedy slashing 10,000 jobs in health department overhaul USA Today, Washington, DC; by Joey Garrison; 3/27/25 Health and Human Secretary Robert F. Kennedy Jr. said Thursday he will cut about 10,000 full-time jobs from the Cabinet department in a dramatic reduction that includes closing half its regional offices as part of a wider Trump administration overhaul of the federal government. Combined with HHS employees who previously accepted buyouts and others who were already fired, the agency's workforce will be sliced by one-quarter from 82,000 full-time employees to 62,000 since President Donald Trump returned to the White House. The Department of Health and Human Services ‒ which oversees the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services ‒ will consolidate the agency's 28 divisions into 15 new divisions in Kennedy's shakeup. ... Among the cuts in key divisions:
The Healing of America with T.R. Reid
03/28/25 at 02:00 AMThe Healing of America with T.R. Reid TCNtalks Podcast; podcast by Chris Comeaux with T.R. Reid; 3/26/25 In this episode of TCN Talks, host Chris Comeaux interviews NY Times bestselling author T. R. Reid. They discuss T. R. Reid’s experiences and insights from researching healthcare systems around the world, particularly focusing on the need for universal coverage and the various models of healthcare delivery. ... This is a great listen as the U.S. spends more on healthcare, yet we are not even in the top 10 in the world. It’s hard to make one aspect of healthcare successful, like Hospice and Palliative Care, if the broader ecosystem it resides in is flawed and unsustainable. Join us; this is very timely.
Trump’s first 60 days: The impact on the home health industry
03/24/25 at 03:00 AMTrump’s first 60 days: The impact on the home health industry Home Health News; by Audrie Martin; 3/20/25 Tax, immigration and diversity, equity and inclusion policies are some of the top-of-mind regulatory concerns for home health agencies in 2025. The first 60 days of the Trump Administration and their impact on the home health care industry were highlighted during a webinar hosted by the Polsinelli Law Firm on Thursday. National Alliance for Care at Home CEO Steve Landers and Home Care Association of America (HCAOA) CEO Jason Lee joined representatives from Polsinelli to discuss potential Medicaid cuts, the importance of extending telehealth services, and the need for workforce expansion. The webinar also explored how executive orders and administrative actions are affecting home care and hospice services. [Click on the title's link to continue reading.]
‘Disturbing’ outlook: Hospices’ top regulatory concerns in 2025
03/24/25 at 02:00 AM‘Disturbing’ outlook: Hospices’ top regulatory concerns in 2025 Hospice News; by Holly Vossel; 3/20/25 Telehealth policies and program integrity concerns represent two of the leading regulatory issues on hospices’ radar this year. Regulatory changes and increasing oversight were the second-most cited concerns among nearly a quarter (21%) of 112 hospice professionals who participated in this year’s Outlook Survey by Hospice News and Homecare Homebase. Challenges around staffing and improved public awareness also topped the list of providers’ concerns. This is the third piece of this three-part Hospice News series that explores the significant regulatory challenges facing hospice providers in 2025.
Medicaid’s role in health and in the health care landscape: LDI expert insights and key takeaways from select publications
03/19/25 at 03:00 AMMedicaid’s role in health and in the health care landscape: LDI expert insights and key takeaways from select publications Penn LDI - Leonard Davis Institute of Health Economics, Philadelphia, PA; by Julia Hinckley, JD; 3/17/25... Medicaid accounts for one-fifth of U.S. health care spending and covers more than a quarter of Americans. LDI researchers have examined the services it provides in supporting aging adults, people with disabilities, and children, as well as its role in health crises such as chronic disease and suicide. ... Below are select key findings from recent peer-reviewed research, along with expert insights for policymakers considering changes to Medicaid funding in the federal budget.