Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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American Hospital Association

25 stories

Federal Policy·13h ago

CMS Launches QualTech Event to Identify AI and Digital Quality Technology Solutions

CMS announced QualTech, a new event seeking technology proposals from U.S.-based teams, academic institutions, nonprofits, private companies, and industry associations. Proposals must address one of four priority areas: AI to protect patients and strengthen quality, AI to increase Medicare annual wellness visits, next-generation digital quality measure calculators, or a national quality hospital dashboard. Applications are due September 4, 2026, with finalists presenting at CMS headquarters to agency leadership. CMS may pursue continued engagement with selected organizations, including potential pilots, demonstrations, or roles in the 2027 CMS Quality Conference.

Industry·1d ago

AHA Network Hosts Webinar on Coordinated Behavioral Health Response Strategies

The American Hospital Association's Community Health Improvement network will host a webinar on August 26, 2026, at noon ET featuring CredibleMind leaders discussing coordinated behavioral health response frameworks. The session will cover upstream prevention strategies, community engagement approaches, cross-sector coordination mechanisms, and accountability frameworks. The webinar is aimed at hospital and health system leaders seeking to strengthen behavioral health service coordination.

Federal Policy·1d ago

CMS Proposes Regulations Codifying Medicare Drug Price Negotiation Program

The Centers for Medicare & Medicaid Services has issued a proposed rule to codify regulations for the Medicare Drug Price Negotiation Program established under the Inflation Reduction Act. The American Hospital Association submitted comments on August 17, 2026, urging CMS to require manufacturers to make negotiated maximum fair prices available at point-of-sale rather than through retrospective rebates. AHA expressed concern that allowing retrospective price adjustments could encourage manufacturers to shift the 340B drug discount program from upfront discounts to rebates. The proposal affects how Medicare Part D beneficiaries and covered entities access negotiated drug prices.

Federal Policy·7d ago

CMS Sets October 13 Deadline for APM Participants to Update Billing Information or Forfeit 2026 Payments

CMS issued an advisory requiring certain alternative payment model participants to update taxpayer identification numbers by October 13, 2026, to receive APM incentive payments for the 2026 payment year based on 2024 performance. The agency could not identify valid TINs for some participants after processing payments. Clinicians who fail to submit updated billing information by the deadline will forfeit their APM incentive payments for this payment period.

Federal Policy·WA·8d ago

HHS Declares Public Health Emergency for Washington Wildfires, Enabling Section 1135 Waivers

HHS Secretary Robert F. Kennedy Jr. declared a public health emergency for Washington state on August 7, 2026, following President Trump's emergency declaration on August 4. The dual declarations enable Washington to request Section 1135 waivers, which allow temporary flexibility from certain Medicare, Medicaid, and CHIP regulatory requirements during the wildfire emergency. The Administration for Strategic Preparedness and Response has deployed regional staff to support state response efforts, and the Washington State Hospital Association is providing resources to assist providers.

Industry·13d ago

AHA Blog Links Rural Hospital Access to Healthcare Affordability and Community Stability

The American Hospital Association published a blog by Shannon Wu, director of payment policy, connecting rural hospital viability to healthcare affordability. Wu argues that proximity to hospitals reduces patient travel costs, enables timely emergency care, and provides access to essential services from primary care to behavioral health and cancer treatment. The blog frames rural hospital closures as threats to community health, stability, and economic well-being beyond individual patient impact. No specific policy action or data is reported.

Federal Policy·13d ago

AHA Urges CMS to Lift Funding Caps in $50 Billion Rural Health Transformation Program

The American Hospital Association submitted comments to CMS on August 5, 2026, requesting changes to the Rural Health Transformation Program, which will distribute $50 billion to rural providers from FY 2026 through FY 2030. AHA urged CMS to eliminate a 15% cap on provider payments and a 20% cap on infrastructure and capital improvement funding for program years two through five. The association also requested that CMS work with Congress to allow states to revise initial applications, extend spending timelines for obligated funds, publicly post state-reported funding data, remove administrative barriers to hospital fund access, and ensure RHTP funds are separately reported on Medicare cost reports.

Federal Policy·16d ago

HHS Announces Revised 340B Rebate Model Pilot for Medicare Negotiated Drugs Starting January 2027

HHS issued a notice announcing a revised 340B Rebate Model Pilot Program that allows qualifying drug manufacturers to use rebates rather than upfront discounts for certain 340B-eligible drugs. The pilot is limited to drugs included on the CMS Medicare Drug Price Negotiation Selected Drug Lists for 2026 and 2027. Manufacturers must submit participation plans to HRSA by August 24, 2026, with approval decisions by September 24, 2026, and approved models taking effect January 1, 2027. The AHA opposes the pilot, citing concerns about administrative burdens, cash-flow disruptions, and compliance costs for hospitals serving vulnerable populations, and is considering legal options to block implementation.

Federal Policy·19d ago

CMS Finalizes 2.3% Medicare Hospital Payment Increase for FY 2027

CMS issued a final rule increasing Medicare inpatient payment rates by a net 2.3% for FY 2027, reflecting a 3.2% market basket increase offset by a 0.9% productivity adjustment. The rule adds $2.9 billion in total hospital payments, including $228 million in DSH and uncompensated care payments and $779 million in new technology payments. The rule expands the Comprehensive Care for Joint Replacement bundled payment model nationwide starting January 1, 2028, making it mandatory for most acute care hospitals with accountability for spending and quality during inpatient stays and 90 days post-discharge. Changes to quality reporting programs include eight new measures for the Inpatient Quality Reporting Program and electronic prior authorization requirements extending to medical benefit drugs beginning in 2028.

Federal Policy·19d ago

CMS Sets Aug. 12 Deadline for Essential Community Provider Applications and Renewals

The Centers for Medicare & Medicaid Services requires current and prospective essential community providers to submit new applications or renew existing ones by August 12, 2026. ECPs include federally qualified health centers, rural health clinics, Ryan White HIV/AIDS Program providers, Title X family planning providers, Indian healthcare providers, and critical access hospitals. CMS encourages existing ECPs to complete annual renewal even without changes to maintain current information for Health Insurance Marketplace issuers seeking ECP network partners. The designation affects providers serving predominantly low-income and medically underserved populations.

Federal Policy·20d ago

HHS Launches National Behavioral Health Quality Pledge with Insurers and Providers

HHS Secretary announced July 29 that dozens of insurers, medical societies, providers, and behavioral health experts have pledged to strengthen behavioral health systems through improved access, quality measurement, patient-centered recovery services, and whole-person care integrating behavioral and physical health. The voluntary initiative commits participants to advancing best practices in mental health and addiction treatment. HHS positioned the effort as part of the administration's broader strategy to address addiction and mental illness and improve long-term patient outcomes.

Federal Policy·20d ago

CMS Finalizes 2.3% IPF Payment Increase for FY 2027, Delays Outlier Cap

CMS issued a final rule July 29 increasing inpatient psychiatric facility payments by 2.3% ($60 million) for fiscal year 2027, reflecting a 3.2% market basket update minus a 0.9-point productivity adjustment. The rule finalizes an outlier payment cap but defers implementation until FY 2028 and excludes facilities with fewer than 50 stays annually. CMS also removes two quality reporting measures on alcohol and tobacco screening effective CY 2026/FY 2028 and modifies implementation of the standardized IPF Patient Assessment Instrument with a lower compliance threshold and extended timeline. Changes take effect October 1, 2026.

Federal Policy·20d ago

CMS Finalizes 2.4% SNF Payment Increase for FY 2027, Expands Quality Reporting

CMS issued a final rule July 29 updating the skilled nursing facility prospective payment system for fiscal year 2027, increasing aggregate payments by 2.4% (3.3% market basket minus 0.9% productivity adjustment). The rule also revises the SNF Quality Reporting Program by removing two COVID-19 vaccination measures, shortening data reporting timelines, and requiring facilities to submit assessment data for all patients regardless of payer source. Changes take effect October 1, 2026. The all-payer reporting requirement expands data submission obligations beyond Medicare to include Medicaid and other payers.

Federal Policy·23d ago

CMS Electronic Prior Authorization Requirements Take Effect January 1, 2027 for Medicare Advantage and Medicaid Managed Care

On January 1, 2027, Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, and federally facilitated exchange QHP issuers must support electronic prior authorization through standardized APIs under CMS's 2024 Interoperability and Prior Authorization final rule. The rule requires impacted payers to enable providers to determine prior authorization requirements, submit requests, and receive approval decisions electronically through EHR integration, using standardized HL7 FHIR-based workflows. The rule does not eliminate prior authorization or change medical necessity criteria — it standardizes the electronic exchange of prior authorization information between providers and health plans. Hospitals should engage EHR vendors and health plans now to prepare workflows, test systems, and train staff before implementation.

Federal Policy·26d ago

CMS Halts Premium Tax Credit Reconciliation Enforcement After Court Injunction

CMS issued implementation guidance July 22 following a federal district court injunction that blocked eight provisions of its 2027 notice of benefit and payment parameters final rule. The injunction, issued July 16, prevents enforcement of provisions set to take effect July 20. CMS directed exchanges to immediately stop removing or denying advance premium tax credits for applicants who failed to file and reconcile prior years' credits, effective for plan years 2026 and 2027. The agency also reinstated the automatic 60-day extension for resolving household income data inconsistencies.

Federal Policy·28d ago

AHA Urges CMS to Scale Back Medicaid State-Directed Payment Limits in Proposed Rule

The American Hospital Association submitted comments July 21, 2026, opposing portions of a CMS proposed rule implementing reconciliation-mandated changes to Medicaid state-directed payments. The rule proposes new limits on targeted fee-for-service payments and SDP design that exceed statutory requirements. CMS projects the rule would reduce Medicaid payments by $510.1 billion over 10 years—more than triple the Congressional Budget Office estimate of $149.4 billion. AHA argues the cuts would reduce care access, worsen workforce shortages, and threaten hospital financial viability, urging CMS to rescind provisions beyond what Congress required and mitigate SDP reductions.

Federal Policy·28d ago

CMS Proposes New Provider Tax Thresholds, Phases Out 6% Hold Harmless Rule

CMS released a proposed rule updating Medicaid provider tax policies following the July 2025 reconciliation law. The rule replaces the current 6% indirect hold harmless threshold with state- and provider class-specific thresholds based on taxes enacted as of July 4, 2025, and implements phased reductions for Medicaid expansion states starting in fiscal year 2028. CMS proposes to sunset the current 75/75 compliance test and establishes a new "Services of Health Insurers" provider tax class, bringing existing state taxes on health insurers under federal oversight. Comments are due 60 days after Federal Register publication.

Federal Policy·29d ago

Maryland Court Enjoins Eight Provisions of CMS 2027 Marketplace Payment Rule

A federal district court in Maryland issued a preliminary injunction on July 16, 2026, blocking eight provisions of CMS's 2027 notice of benefit and payment parameters final rule. The enjoined provisions include expanded out-of-pocket maximums for bronze and catastrophic plans, broader catastrophic plan eligibility, relaxed network adequacy standards, and a new pathway for non-network plans to qualify as marketplace coverage. The court found plaintiffs likely to succeed on Administrative Procedure Act claims and that irreparable harm would occur without relief. The injunction took effect July 20, 2026, while the remainder of the rule proceeded as scheduled.

Federal Policy·30d ago

CMS Updates PAMA Lab Data Reporting FAQ Ahead of July 31 Deadline

The Centers for Medicare & Medicaid Services has released an updated FAQ on Protecting Access to Medicare Act private payer data reporting requirements for hospital outreach laboratories. The deadline is July 31, 2026, for laboratories to report private payer clinical diagnostic laboratory data for services furnished during the first six months of 2025. Reporting must include Healthcare Common Procedure Coding System codes, associated private payer rates, and volume data. CMS has published a guide and additional resources to help hospital outreach laboratories determine their reporting obligations.

Federal Policy·33d ago

CMS Launches Risk-Based Survey Process for High-Performing Nursing Homes Nationwide

CMS announced July 16 nationwide implementation of a risk-based survey process for high-performing nursing homes, effective September 2026 following state agency training. Approximately 12% of nursing facilities will initially qualify based on criteria including five-star ratings, zero harm citations, and accurate data submission. Qualifying facilities receive streamlined recertification surveys and a new Care Compare icon, though state agencies retain authority to use traditional surveys when safety concerns arise. All nursing homes continue receiving surveys at least every 15 months regardless of performance tier.

Federal Policy·33d ago

DHS Finalizes Public Charge Rule Tying Medicaid and CHIP Receipt to Immigration Bonds

The Department of Homeland Security on July 16 finalized a rule rescinding 2022 public charge regulations and establishing that receipt of Medicaid or CHIP will breach public charge bonds for immigrants. The final rule removes previous exemptions and the 2022 Public Charge Inadmissibility Framework definitions. It takes effect 60 days after Federal Register publication, likely in mid-September 2026. The change may reduce Medicaid and CHIP enrollment among eligible immigrant populations, affecting managed care plan membership and revenue.

Federal Policy·34d ago

AHA Urges CMS to Preserve Essential Health Benefits Coverage Standards in RFI Response

The American Hospital Association submitted comments July 15 responding to a CMS request for information on potential modifications to the Affordable Care Act's Essential Health Benefits framework. AHA supported updating EHBs to reflect changes in healthcare delivery but warned against changes that would reduce coverage adequacy. The association emphasized that affordability requires adequate benefits, not just lower premiums, and cautioned that reduced benefits, narrower standards, or increased cost-sharing would increase patient financial exposure. CMS is reviewing the EHB framework, which establishes minimum coverage requirements for comprehensive insurance.

Federal Policy·41d ago

CMS Ends Fast-Track Review Process for Medicaid 1115 Waiver Extensions

CMS announced July 7 that it is eliminating the fast-track review process for certain Medicaid section 1115 demonstration extensions, formally rescinding 2015 guidance that established the expedited pathway. The change stems from a July 2025 reconciliation bill requirement that the CMS chief actuary certify budget neutrality for all 1115 demonstrations, effective January 1, 2027. CMS stated the fast-track process would make it difficult to evaluate renewal applications under the new budget neutrality certification requirements. The bulletin did not specify when the elimination takes effect, but states should anticipate longer review timelines for waiver extensions.

Federal Policy·49d ago

AHA Opposes Bill Adding IRS Schedule H Reporting Requirements for Tax-Exempt Hospitals

The American Hospital Association submitted comments June 30 to the House Ways and Means Committee opposing H.R. 9504, the Tax-Exempt Hospital Transparency Act, ahead of a scheduled July 1 markup. The bill would add reporting requirements to hospitals' Schedule H IRS forms, affecting nearly two-thirds of all hospitals. While the AHA acknowledged improvements from an earlier draft — including removal of a parallel for-profit tax calculation and inclusion of standardized definitions — it maintains serious concerns about administrative and financial burdens, particularly requirements focused on financial assistance reporting that exclude Medicaid shortfall and other community benefit components. The bill includes carve-outs for small facilities but still requires eventual compliance.

Managed Care·CO·50d ago

Denver Health CEO Discusses Housing Program for Medicaid, Uninsured Patients

Denver Health CEO Donna Lynne describes the health system's Housing Outreach, Partnerships and Engagement (HOPE) program, which provides 34 apartments to patients experiencing homelessness or housing insecurity. The program, which won the 2026 AHA Dick Davidson NOVA Award, includes 20 recuperative care units with average 2-3 day stays and 14 longer-term apartments for up to six months. Denver Health serves a patient population that is 47% Medicaid and 15% uninsured; the program reduces length of stay and readmissions for homeless patients, who typically stay 2.5 times longer than housed patients. The health system partners with Colorado Coalition for the Homeless and Denver Housing Authority to transition patients to permanent housing.

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