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Thursday, August 6 · 6 stories
- Federal Policy
McDermott Hosts Webinar on 340B Provisions in CY 2027 OPPS Proposed Rule
McDermott Will & Emery is hosting a webinar on August 11, 2026 at 12:00 pm ET to discuss 340B program changes proposed in CMS's CY 2027 Outpatient Prospective Payment System (OPPS) proposed rule. The webinar will cover key provisions affecting 340B hospitals and non-340B hospitals, potential implications, and considerations for stakeholders preparing comments before the CMS deadline. The session is designed to help organizations understand the proposed changes and formulate effective comments during the rulemaking period.
- Federal Policy
Georgetown Researcher Testifies on Medicaid Program Before Senate Budget Committee
Andy Schneider of Georgetown University's Center for Children and Families testified before the U.S. Senate Budget Committee on August 4, 2026, at a hearing titled "Medicaid the Reality." The testimony addressed the current state of the Medicaid program for federal policymakers. The hearing reflects ongoing Congressional scrutiny of Medicaid financing and operations, which could inform future legislative or oversight activity affecting state agencies and managed care plans.
- Federal Policy
Senate Democrats Urge CMS to Withdraw Medicaid Work Requirements Rule
All 47 Senate Democrats and independents sent a letter to CMS Administrator Mehmet Oz on August 4, 2026, calling for withdrawal of the June 2026 interim final rule on Medicaid work requirements. The rule establishes community engagement requirements for the Medicaid expansion population beginning in 2027. The letter represents unified Democratic opposition to the policy ahead of its planned implementation. State Medicaid agencies and managed care organizations face operational and compliance implications if the rule proceeds or is rescinded.
- Federal Policy
CMS Withholds $1 Billion in Medicaid Payments to California and Minnesota Pending Documentation
On July 21, 2026, CMS and HHS announced they are withholding over $1 billion in federal Medicaid payments to California ($867 million) and Minnesota ($199 million) pending submission of additional documentation showing certain claims meet federal billing requirements. The payment deferrals follow financial audits that identified compliance concerns. The states must provide supplemental documentation before CMS will release the withheld funds. This action represents a significant federal enforcement step affecting two major state Medicaid programs and their cash flow for services already delivered.
- Federal Policy
CMS Proposes Home Health Payment Changes for Palliative Care and Home Infusion
CMS released its CY 2027 Home Health Prospective Payment System proposed rule, introducing payment changes for palliative care services, home infusion therapy, and durable medical equipment in the home health setting. The proposed rule affects Medicare home health agencies and their payment structures beginning January 1, 2027. The changes reflect CMS's broader strategy to expand access to home-based care alternatives and shift care delivery from institutional to home settings. Comments on the proposed rule are typically due 60 days after publication in the Federal Register.
- Federal Policy
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.
Wednesday, August 5 · 5 stories
- Federal Policy
Expert Panel Issues Guidelines on GLP-1 Use in Pregnancy
An international expert panel published systematic review and consensus guidelines on incretin-based medications (GLP-1s including semaglutide, liraglutide, dulaglutide, exenatide) in women's reproductive health, covering use before, during, and after pregnancy. The guidance, published in Obesity Reviews and based on 34 studies, provides counseling recommendations for clinicians treating patients on these medications. The guidelines address an emerging clinical question as GLP-1 use expands among women of reproductive age, including Medicaid beneficiaries with obesity and diabetes.
- Federal Policy
CMS Proposes 340B Cuts, Site-Neutral Payment Changes for 2027 Outpatient Rule
CMS released a proposed 2027 outpatient payment rule on July 2, 2026, that would cut billions from 340B drug payments and expand site-neutral payment policies affecting hospital reimbursement. The rule compounds financial pressure on hospitals already facing margin challenges, combining payment reductions that hospital finance leaders have previously fought separately. Comments on the proposed rule are due under the standard federal rulemaking timeline, typically 60 days from publication. The combined effect threatens Medicaid DSH hospitals and safety-net providers that rely heavily on 340B revenue and outpatient volume.
- Federal Policy
CMS Re-Establishes Data Matching Program With Department of War for ACA Coverage Verification
CMS is re-establishing a Privacy Act matching program with the Department of War to verify minimum essential coverage under the Affordable Care Act through War Department health benefit plans. The matching program allows CMS to cross-reference enrollment data to confirm ACA coverage requirements are met. The notice was published August 5, 2026, under Privacy Act requirements. This routine administrative action maintains existing data-sharing arrangements between federal agencies for coverage verification purposes.
- Federal Policy
Pediatricians Develop Independent Vaccine Guidance After CDC Policy Changes
Following changes to federal vaccine recommendations under the Trump administration, pediatricians and state health departments report they can no longer rely on CDC guidance as a trusted resource for families. Some providers are developing their own vaccine schedules and educational materials. The shift affects Medicaid-enrolled children, who comprise approximately 40% of the pediatric population and depend on EPSDT-mandated preventive services including immunizations. State Medicaid agencies may face inconsistent vaccine coverage determinations if provider guidance diverges from federal standards.
- Federal Policy
CMS Proposes Restrictions on Remote Patient Monitoring in 2027 Fee Schedule
CMS issued the CY 2027 Physician Fee Schedule Proposed Rule limiting remote patient monitoring and remote therapeutic monitoring services. The proposal restricts outsourced clinical staffing, imposes new billing requirements, and reduces reimbursement for certain services. Changes would take effect January 1, 2027. The restrictions reverse CMS's 2025 expansion of RPM/RTM access and could significantly affect Medicaid managed care organizations and providers using remote monitoring for chronic condition management, particularly for dialysis and other high-cost populations.
Tuesday, August 4 · 6 stories
- Federal Policy
HHS Secretary Kennedy Endorses Measles Vaccine Amid Outbreak Discussions
Health and Human Services Secretary Robert F. Kennedy Jr. endorsed the measles vaccine during a CNN interview on August 3, 2026, while making additional claims about other vaccines and RSV during ongoing measles outbreaks. The statement represents the Secretary's public position on measles immunization policy as the nation's top health official. The endorsement comes as federal and state health agencies manage measles outbreak response and vaccination campaigns. HHS guidance on childhood vaccinations influences state Medicaid EPSDT requirements, managed care quality metrics, and VFC program administration.
- Federal Policy
CMS Seeks Public Comment on Potential CPT Coding System Reforms in 2027 Fee Schedule Rule
CMS published a Request for Information on July 16, 2026, soliciting stakeholder feedback on potential reforms to the American Medical Association's Current Procedural Terminology (CPT) coding system. The RFI appears in the Calendar Year 2027 Physician Fee Schedule Proposed Rule (CMS-1848-P). Comments are due 60 days after Federal Register publication, typically in mid-September 2026. The inquiry signals CMS consideration of structural changes to how physician and outpatient services are coded and reimbursed across Medicare and Medicaid programs.
- Federal Policy
CMS Issues FY 2027 IPPS Final Rule With GME, LTCH, and Quality Reporting Changes
CMS published its final rule updating Medicare inpatient prospective payment systems for acute care hospitals and long-term care hospitals for fiscal year 2027, effective October 1, 2026. The rule revises operating and capital payment rates, modifies graduate medical education policies for teaching hospitals, updates LTCH PPS rates, and changes requirements for hospital quality reporting programs. HHS also adopts updated health IT standards. While this is a Medicare rule, Medicaid managed care organizations and state agencies should monitor GME policy changes and quality measure updates that often influence Medicaid hospital payment methodologies and managed care contract requirements.
- Federal Policy
CMS Announces Healthcare Advisory Committee Virtual Meetings for FY 2026-2027
CMS has announced virtual public meetings of the Healthcare Advisory Committee (HAC) for fiscal year 2026-2027. The Committee advises the HHS Secretary and CMS Administrator on healthcare system improvements consistent with the Executive Order establishing the President's Make American Healthy Again Commission. The meetings are open to public participation. The announcement provides stakeholders advance notice of opportunities to observe federal healthcare policy deliberations.
- Federal Policy
HHS Officials Dispute State Concerns Over Medicaid Coverage Loss Projections
HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz are characterizing concerns about Medicaid coverage losses as "myths," while state Medicaid directors report that recent federal policy changes are expected to result in significant disenrollment. The dispute centers on whether new eligibility verification requirements, work requirements, or other administrative changes constitute "cuts" when they reduce enrollment. State agencies are preparing for increased disenrollment based on federal guidance issued in recent weeks. The disagreement highlights tension between federal policymakers and state administrators responsible for implementing Medicaid changes.
- Federal Policy
Federal Medicaid Work Requirements Exclude Homeless Individuals from Exemptions
Federal Medicaid work requirements do not include homelessness as an exemption category, despite assurances that vulnerable populations would receive waivers. Homeless individuals must meet work or community engagement requirements to maintain coverage, even though securing employment typically requires stable housing. The rule affects Medicaid beneficiaries experiencing homelessness in states that adopt work requirements. This gap exposes a population already facing barriers to healthcare access to potential coverage loss.
Monday, August 3 · 10 stories
- Federal Policy
Advocates Warn Trump Administration Budget Proposals Could Cut Medicaid Funding
On Medicaid's 61st anniversary, advocacy groups are raising concerns about potential funding cuts in budget proposals from the Trump administration. The warnings come as beneficiaries like 55-year-old Ivon Meneses rely on Medicaid for coverage of chronic conditions including asthma and diabetes. Advocates are highlighting the program's role as a safety net and the potential impact of federal budget actions on coverage and access. The timing of these warnings coincides with the program's July 30th anniversary, drawing attention to proposed changes that could affect state Medicaid budgets and beneficiary eligibility.
- Federal Policy
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 · ME
Medicaid Cuts in HR 1 Expected to Drop 31,000 Maine Enrollees, Strain Rural Hospitals
The "One Big Beautiful Bill Act" (HR 1), enacted in July 2025, imposed substantial Medicaid funding reductions and new administrative requirements. In Maine, approximately 31,000 enrollees are projected to lose coverage due to these administrative burdens. Those losing coverage are expected to shift to charity care at hospitals. The changes threaten financial stability for rural hospitals and local economies dependent on Medicaid reimbursement.
