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All posts tagged with “Regulatory News | Medicaid.”



HHS proposal slashes Medicare SHIP funds

04/23/25 at 03:00 AM

HHS proposal slashes Medicare SHIP funds MSN; by Mary Helen Gillespie; 4/22/25 The Trump administration is proposing federal budget cuts to Medicare State Health Insurance Assistance Programs (SHIP) and seven additional elder health care safety net programs that assist older Americans. ... SHIP programs have been under the umbrella of the Health and Human Services agency Administration for Community Living. The pre-decisional budget lists funds for seven other ACL programs that would be eliminated are:

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American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model

04/23/25 at 03:00 AM

American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model Stock Titan, Globe Newswire, Fort Myers, FL; 4/22/25 American Oncology Network (AON), one of the nation’s fastest-growing community oncology networks, today announced strong results from the first performance period in the Centers for Medicare & Medicaid Innovation’s (CMMI) Enhancing Oncology Model (EOM). AON practices participating in the program—in collaboration with value-based cancer care enabler Thyme Care—achieved nearly $6M in cost savings for the Centers for Medicare & Medicaid Services (CMS). AON also earned a performance-based payment while improving patient experience and outcomes.

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Supreme Court hears ‘crucial’ case today on free preventive health care

04/22/25 at 03:00 AM

Supreme Court hears ‘crucial’ case today on free preventive health care KFF Health News; 4/21/25 The lawsuit, Kennedy v. Braidwood Management, could have far-reaching consequences for the health coverage of tens of millions of Americans. A ruling is expected in June. ... The Supreme Court on Monday is set to hear arguments in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests and checkups for free. Experts say the court’s ruling in the case, called Kennedy v. Braidwood Management, could have sweeping consequences for patient access to preventive health care across the United States.

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Value-based palliative care moving toward risk-based models

04/22/25 at 03:00 AM

Value-based palliative care moving toward risk-based models Hospice News; by Jim Parker; 4/21/25 Risk-based contracts may be the future of palliative care reimbursement as Medicare Advantage continues to ascend. The simple term “value-based care” belies its complexity. The term can refer to any number of payment models that are designed to reduce total cost of care and improve outcomes. While most palliative care remains locked in the fee-for-service realm, most value-based organizations like MA plans are moving towards it, according to Dr. Gavin Baumgardner, vice president and national medical director for complex and palliative care at Contessa Health, a subsidiary of Amedisys (Nasdaq: AMED). 

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HHS cuts pose threat to older Americans' health and safety

04/18/25 at 03:00 AM

HHS cuts pose threat to older Americans' health and safety Newsweek; by Kristin Lees Haggerty and Scott Bane - The National Collaboratory to Address Elder Mistreatment at Education Development Center (EDC); The John A. Hartford Foundation; 4/17/2 On March 27, 2025, the federal government announced major cuts to the department of Health and Human Services (HHS). ... Sounding the Alarm for Elder Justice: The population of older adults is rapidly growing, and one in 10 experience abuse, neglect, and/or exploitation—a risk that is even higher for those living with dementia. ... Cutting services to older adults will increase these risks and costs. Moreover, ... 11.5 million family and friend caregivers provide over 80 percent of help needed for people living with dementia in the U.S. Without access to services like Meal on Wheels, adult day care, and respite care, we can expect caregiver burden and strain to increase significantly and with it, rates of elder abuse, emergency department visits, hospitalizations, and nursing home placements. We know this because of the abuse spike seen clearly during the COVID-19 pandemic, which doubled to over 20 percent of older adults, as services were limited, and older adults were socially isolated. HHS cuts are also likely to result in loss of specialized expertise in identifying and addressing elder mistreatment, so that when elder abuse does occur, we won't have the services to stop it and make sure it won't happen again.

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Regulatory leaked HHS budget signals $40B in cuts, assumes ACA subsidies expire

04/18/25 at 03:00 AM

Regulatory leaked HHS budget signals $40B in cuts, assumes ACA subsidies expire Fierce Healthcare; by Noah Tong; 4/17/25 Department of Health and Human Services (HHS) reorganization plans appear to have been revealed through a leaked Office of Management and Budget (OMB) document. The 64-page PDF with HHS’ plans were first reported by Inside Medicine and later reported by The Washington Post and other news publications. In an update, Inside Medicine said the entire document was authenticated by The Washington Post. ... While the restructuring was broadly announced, and individual offices have been reportedly axed in recent weeks, the leak provides greater insight into how the reorganization, firings, reductions in force and office eliminations and consolidations will fundamentally alter the agency.

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8 health system CEOs on the turbulence defining 2025

04/18/25 at 02:00 AM

8 health system CEOs on the turbulence defining 2025 Becker's Hospital Review; by Kelly Gooch and Kristin Kuchno; 4/16/25 From capacity constraints to reimbursement pressures, health system CEOs are navigating a changing healthcare landscape. One of the top concerns in 2025 is the potential for Medicaid funding cuts. A recent report estimates hospitals could face a $31.9 billion loss in revenue if federal proposals to scale back Medicaid expansion move forward. CEOs from across the country — including safety-net systems, academic medical centers and expanding regional providers — recently shared how they are preparing for continued uncertainty and what strategies they are prioritizing in response.

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CMS to withdraw federal Medicaid match for workforce, social needs, and infrastructure: What states, health care providers and community organizations need to know

04/17/25 at 03:00 AM

CMS to withdraw federal Medicaid match for workforce, social needs, and infrastructure: What states, health care providers and community organizations need to know The National Law Review; by Margia Corner, Adam Herbst of Sheppard, Mullin, Richter & Hampton LLP; 4/16/25 In a move signaling a major shift in federal priorities, the Centers for Medicare & Medicaid Services (“CMS”) recently announced it will limit federal funding for state Medicaid initiatives that support services beyond direct medical care. ... On April 10, CMS notified states that it will no longer approve new, or renew existing, state proposals for Section 1115(a) Demonstration Project expenditure authority to provide federal matching funds for state expenditures for designated state health programs (“DSHP”) and designated state investment programs (“DSIP”). 

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HHS restructuring and workforce reductions – key implications for the health care industry

04/17/25 at 02:00 AM

HHS restructuring and workforce reductions – key implications for the health care industry JD Supra; by Mintz.com; 4/15/25 ... As part of the department-wide restructuring plan, HHS is in the process of consolidating 28 different divisions into 15 divisions. As of April 4, 2025, it had also reduced the number of Regional Offices from ten to five. ... 

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CMS halts spending for nonmedical in-home Medicaid services, likely affecting providers

04/16/25 at 03:00 AM

CMS 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.

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CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid Partnership

04/15/25 at 03:00 AM

CMS 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.

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Community Catalyst leads national response against new rule that threatens health care access

04/15/25 at 03:00 AM

Community 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, ...

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Closing the gap in end-of life care coverage: The role of nonprofits in policy advocacy

04/15/25 at 03:00 AM

Closing 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:

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CMS drops 5 proposed payment rules for 2026: 25 things to know

04/15/25 at 02:00 AM

CMS 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: ...

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National Alliance for Care at Home responds to the FY 2026 Hospice Proposed Rule

04/15/25 at 02:00 AM

National 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. ..."

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Dr. Oz outlines vision for CMS: 8 notes

04/14/25 at 03:00 AM

Dr. 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:

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Medicare and Medicaid officials finalize rule to clarify that medical marijuana isn’t covered by federal health programs

04/10/25 at 03:00 AM

Medicare 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 ...]

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Trump administration continues to defend nursing home staffing mandate in court

04/08/25 at 03:00 AM

Trump 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. 

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AGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers

04/07/25 at 03:00 AM

AGG 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.

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New administration’s appointees confirmed to lead key health agencies

04/07/25 at 03:00 AM

New 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:

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Senate confirms Oz as head of agency that runs Medicare, Medicaid

04/04/25 at 03:00 AM

Dr. 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 ...]

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HHS restructures duals, PACE offices amid department overhaul

04/04/25 at 03:00 AM

HHS 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.

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Trump administration to shut down CMS, HHS minority health offices amid restructuring

04/04/25 at 03:00 AM

Trump 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 ...]

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Medicare Administrative Contractors [MACs] did not consistently meet Medicare Cost Report Oversight Requirements

04/02/25 at 03:00 AM

Medicare 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.

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Mass layoffs hit workers at HHS; sweeping cuts extend to CDC, NIH, FDA: Recap

04/02/25 at 03:00 AM

Mass 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.

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