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Thursday, August 20 · 3 stories
- Federal Policy
CMS Establishes Privacy Act System for Nurses for Nursing Homes Program
CMS is establishing a new Privacy Act system of records for the Nurses for Nursing Homes Program (NNHP), which will collect personally identifiable information on individuals who apply for, participate in, or support the program. Records will include demographic data, professional licensure, education and training information, employment and nursing facility affiliation, payment information, and tax reporting. The system supports administration of a nursing workforce incentive program designed to strengthen staffing at Medicare and Medicaid-certified nursing homes, with a focus on underserved and rural communities. The notice was published August 20, 2026.
- Federal Policy
HHS Adds Two Peer Support Programs to Title IV-E Clearinghouse for Federal Reimbursement
The Department of Health and Human Services announced August 18 that its Administration for Children and Families added two behavioral health peer support programs to the Title IV-E Prevention Services Clearinghouse: Family-Based Recovery (in-home treatment for parents with addiction who have children ages 0-5) and Wellness Recovery Action Plan (peer-facilitated mental health and addiction recovery coaching). The additions allow all states to claim federal reimbursement for these services under Title IV-E prevention. This expands state options for using federal funds to support families with substance use disorders and mental health conditions in child welfare prevention programs.
Wednesday, August 19 · 7 stories
- Federal Policy
CMS Proposes Electronic Prior Authorization Incentives in Medicare Fee Schedule
CMS released a proposed rule on July 14, 2026, to incentivize electronic prior authorization through the Medicare Physician Fee Schedule for CY 2027. The proposal targets Medicare Ambulatory Specialty Models and the Merit-based Incentive Payment System, building on existing prior authorization requirements for health plans. The rule focuses on provider-side incentives rather than plan mandates. Comment periods and effective dates were not specified in the excerpt.
- Federal Policy
Rural Hospital CEO Defends $50B Federal Transformation Program Amid Implementation Concerns
A rural hospital CEO is defending the $50 billion Rural Health Transformation Program included in HR-1 against skepticism from other rural leaders. Critics have questioned whether the federal funding will reach intended provider recipients and raised concerns about potential state-level redirection of funds before they reach hospitals. The debate reflects ongoing uncertainty about the program's design and implementation mechanisms, though specific details about fund distribution timelines, eligibility criteria, or Medicaid program integration are not provided in the available content.
- Federal Policy · CT
Connecticut Providers Prepare for 110K HUSKY Disenrollments Under Federal Eligibility Changes
Federal Medicaid eligibility changes take effect in January 2027 and could result in approximately 110,000 Connecticut residents losing HUSKY coverage. Connecticut health care providers, including hospitals and clinics, are actively preparing for the expected enrollment losses. The changes stem from federal legislation that modifies Medicaid eligibility criteria. Providers are most concerned about continuity of care disruptions and potential increases in uncompensated care as beneficiaries lose coverage.
- Federal Policy
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.
- Federal Policy · WI
Wisconsin Governor Candidate Criticized Over 2025 Medicaid Cut Vote
Healthcare advocates are targeting Wisconsin gubernatorial candidate Tom Tiffany over his June 2025 vote for HR 1, federal legislation that included Medicaid cuts. Tiffany, a Republican U.S. Representative, was among all House Republicans who supported the bill, which passed with no Democratic votes. The vote has become a focal point in criticism from healthcare advocates as Tiffany campaigns for governor. The article does not specify what Medicaid cuts were included in HR 1 or their implementation timeline.
- Federal Policy
Georgetown Analysis Shows Medicaid Covers 43% of Children Under Age 3
Georgetown University's Center for Children and Families analyzed 2015-2024 Census data on health coverage for infants and toddlers under age 3. The analysis uses American Community Survey data to track coverage trends for this population, which has historically high Medicaid enrollment rates. The brief provides state-level and national estimates of coverage patterns over the decade. The findings offer a baseline for assessing coverage changes as states continue to complete Medicaid redeterminations following the end of continuous enrollment.
- Federal Policy
HHS Awards $96.7 Million in SAMHSA Behavioral Health Grants
The Department of Health and Human Services announced $96.7 million in grants through the Substance Abuse and Mental Health Services Administration for behavioral health services. The grants fund programs for individuals with serious mental illness experiencing homelessness, suicide prevention and early intervention, substance use disorder treatment, training and technical assistance, peer support, and disaster-related emotional support. The funding supports service delivery infrastructure that Medicaid managed care organizations and behavioral health providers rely on to serve beneficiaries with complex needs.
Tuesday, August 18 · 5 stories
- Federal Policy
Former CMS Administrator Calls for Healthcare Data Interoperability After Kill the Clipboard Anniversary
Former CMS Administrator Seema Verma published commentary calling for improved healthcare data connectivity, marking one year since CMS launched its "Kill the Clipboard" initiative. The initiative aims to reduce administrative burden by enabling electronic data exchange across healthcare systems. Verma argues that while healthcare has been digitized, meaningful interoperability remains incomplete. For Medicaid programs, improved data exchange could streamline eligibility verification, care coordination across MCOs and providers, and integration of clinical and administrative data systems.
- Federal Policy
House Democrats Introduce Medicare At Home Act Adding Part B Home Care Benefit
House Democrats introduced the Medicare At Home Act, legislation that would add a home care benefit to Medicare Part B. The bill follows a Democratic policy framework released two months earlier. If enacted, the legislation would expand Medicare coverage to include home care services currently excluded from the program. The bill does not directly affect Medicaid managed care operations, though state Medicaid agencies managing dual-eligible populations and Medicare-Medicaid Plans would need to coordinate benefits if the legislation advances.
- Federal Policy
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
CDC Reports Kindergarten MMR Coverage Falls Below Herd Immunity Threshold at 92.4%
CDC data for the 2025-26 school year shows kindergarten vaccination coverage for measles, mumps, and rubella (MMR) dropped to 92.4%, down from 92.5% the prior year and below the 95% herd immunity threshold recommended by public health officials. Exemption rates reached a record 4.2%. The decline in vaccination rates raises public health concerns about potential disease outbreaks and may affect Medicaid EPSDT compliance, as childhood immunizations are a required preventive service under Early and Periodic Screening, Diagnostic and Treatment benefits for children enrolled in Medicaid and CHIP.
- Federal Policy
ONC Seeks Comment on TEFCA Performance Monitoring Data Collection
The Office of the National Coordinator for Health Information Technology (ONC) published a notice on August 17, 2026, requesting public comment on a three-year data collection initiative for the Trusted Exchange Framework and Common Agreement (TEFCA). The proposed collection would gather routine feedback on service delivery and program performance from Qualified Health Information Networks (QHINs). Comments are due under standard federal notice procedures. For Medicaid programs increasingly reliant on interoperability for care coordination, managed care reporting, and health information exchange, this reflects ONC's evolving oversight approach for the national framework governing health data exchange among QHINs.
Monday, August 17 · 1 story
- Federal Policy
CMS Seeks Comment on AI in Medicine Through Physician Fee Schedule RFI
CMS has included questions about artificial intelligence in healthcare delivery within its Calendar Year 2027 Physician Fee Schedule proposed rule Request for Information. Comments are due in less than 30 days from the article date (mid-September 2026). The RFI solicits stakeholder input from physicians, health systems, and technology companies on how AI should be addressed in Medicare payment policy. This matters for Medicaid stakeholders because federal AI policy framework developed for Medicare typically influences subsequent Medicaid guidance on emerging technologies, particularly in managed care quality measurement and provider reimbursement.
Sunday, August 16 · 1 story
- Federal Policy
Senate Bill Would Reset Home Health Base Rate, Expand CMS Fraud Authority
Sen. Susan Collins introduced legislation to reset the Medicare home health base payment rate and grant CMS additional fraud enforcement tools. The bill applies to Medicare home health, not Medicaid home and community-based services. It reflects congressional scrutiny of home health fraud while supporting payment stability. No effective date or timeline for committee action has been announced.
Friday, August 14 · 3 stories
- Federal Policy
37 States Face Cuts to Hospital State Directed Payments Under 2025 Reconciliation Law
At least 37 states operate Medicaid state directed payment (SDP) arrangements for hospital services that exceed new federal limits established by the 2025 reconciliation law. These limits, when fully implemented, will require states to reduce federal spending on hospital SDPs that currently surpass statutory caps. The analysis estimates the scope of current federal spending that will be affected as states come into compliance with the new restrictions. Hospital SDPs, which allow states to direct managed care plans to make supplemental payments to hospitals, have grown significantly in recent years and represent a major revenue source for safety-net hospitals.
- Federal Policy
CMS and CDC Launch CLIA Modernization Review for Clinical Laboratory Standards
The Centers for Medicare & Medicaid Services and Centers for Disease Control and Prevention have initiated a review to modernize the Clinical Laboratory Improvement Amendments of 1988 (CLIA), the federal regulatory framework governing clinical laboratory testing standards. The review will examine updates to quality standards, personnel qualifications, proficiency testing, and enforcement mechanisms that apply to all clinical laboratories performing testing on human specimens, including those serving Medicaid beneficiaries. Timing for proposed regulatory changes has not been announced. For Medicaid programs, CLIA compliance is a condition of participation for laboratory services reimbursement, and any regulatory changes will directly affect state agency oversight responsibilities, managed care quality assurance requirements, and laboratory provider compliance obligations.
- Federal Policy
Analysis Examines ICHIA Coverage Option as Mitigation for 2025 Reconciliation Coverage Losses
A policy brief analyzes how state use of the Immigrant Children's Health Improvement Act (ICHIA) option could offset coverage losses among lawfully present immigrant children resulting from the 2025 reconciliation law. The analysis examines current enrollment patterns and coverage rates for noncitizen children to assess ICHIA's potential role. The brief provides states with data on how expanded ICHIA adoption could preserve Medicaid and CHIP coverage for eligible immigrant children affected by reconciliation-related restrictions. This matters for state Medicaid agencies evaluating coverage preservation strategies and assessing budget implications of expanded ICHIA elections.
Thursday, August 13 · 6 stories
- Federal Policy
Physician Advocates for Site-Neutral Payment Reform in Medicare
A physician is arguing that Congress should enact site-neutral payment reforms in Medicare to reduce healthcare spending driven by hospital consolidation. Site-neutral payments would eliminate higher Medicare reimbursement rates for services provided in hospital outpatient departments compared to physician offices. The physician contends this reform would lower costs without compromising patient care quality. While the article focuses on Medicare policy, site-neutral payment discussions often influence Medicaid policy development, particularly as states manage their own fee schedules and provider networks.
