All stories
Jump to date
Thursday, October 1 · 48 stories
- Federal Policy · AL
CMS Awards Nearly $55 Million for Rural Maternal, Emergency Care
CMS announced nearly $55 million in new federal funding to expand rural maternal health services, emergency care, cancer screening, and healthcare workforce development, with a specific focus on Alabama's rural healthcare workforce. The funding is aimed at rural hospitals and providers facing access gaps in obstetric and emergency services. The announcement does not specify the exact award mechanism or full list of recipient states beyond Alabama's workforce component. Rural Medicaid beneficiaries, who rely heavily on these facilities for maternal and emergency services, stand to benefit from expanded capacity and workforce investment.
- Legal
Court Strips Integration Mandate From Section 504 Rules
A federal judge in Texas v. Kennedy agreed to remove "most integrated setting" language from Section 504 regulations after the Justice Department, originally the defendant, switched sides to side with states challenging the rule. The reversal follows a June DOJ opinion disavowing the integration requirement and a July announcement that DOJ would stop relying on its enforcement guidance. Disability rights advocates say the ruling does not undo ADA or Olmstead protections but creates legal ambiguity that could let states scale back community-based services, particularly as states face pressure to cut Medicaid spending. Advocacy groups are now backing legislation to codify integration protections and working with states directly to strengthen disability laws.
- State Policy · WI
Federal Immigration Cuts Worsen Wisconsin Long-Term Care Staffing Crisis
Reductions in refugee admissions and Temporary Protected Status under the Trump administration have halted overseas recruitment pipelines that Wisconsin long-term care facilities relied on to fill caregiver positions. The resulting labor shortage has forced some facilities to close long-term care beds, reducing capacity for residents who depend on these services, many of whom are covered by Medicaid. The cuts affect nursing homes and other long-term care providers statewide that have struggled for years with chronic direct-care workforce shortages. The story reports an ongoing crisis rather than a single new policy action, reflecting the compounding effect of federal immigration policy on state long-term care capacity.
- State Policy · PA
Pennsylvania House Advances Menopause Treatment Coverage Bill Package
Pennsylvania House committees have advanced seven bills addressing perimenopause and menopause care, including measures from Reps. Liz Hanbidge and Morgan Cephas that would expand Medicaid and private insurance coverage for hormonal and non-hormonal menopause therapy and pelvic floor therapy. Other bills in the package address provider education partnerships with the Department of Health and workplace accommodations for menopausal symptoms. Some Republicans opposed the measures over concerns about increased Medicaid costs. The bills are still moving through House committees, with no final floor votes or effective dates yet reported.
- Industry
States, Hospitals Expand Automatic Enrollment in Charity Care
A Tradeoffs/KFF Health News explainer describes how hospitals use "presumptive eligibility" to automatically screen patients for charity care and wipe out medical bills without requiring a formal application. Nonprofit hospitals increasingly use this approach to comply with ACA requirements to identify financial-assistance-eligible patients before pursuing debt collection, with screening rates rising from about 70% to nearly 90% of tax-exempt hospitals since 2016. Six states, California, Delaware, Illinois, Maryland, North Carolina, and Oregon, mandate presumptive eligibility for certain patient groups, though criteria vary widely and remain difficult for patients to find. For-profit and public hospitals are not subject to the federal reporting requirement, leaving gaps in who benefits from automatic debt relief.
- Federal Policy
CMS Finalizes International Reference Pricing Model for Part B Drugs
CMS finalized the GLOBE Model, a mandatory payment model tying Medicare Part B drug inflation rebates to prices paid in 19 reference countries, per a Sept. 30 CMS news release. The regulation takes effect Nov. 30, with voluntary manufacturer data submission beginning Jan. 1, 2027, a five-year performance period from April 2027 through March 2032, and a seven-year payment period running through March 2034. The final model is narrower than proposed, excluding orphan-only drugs, biosimilars, plasma-derived products and certain cell and gene therapies, cutting projected Medicare Part B savings from $8.4 billion to $440 million over the payment period. GLOBE applies to a random sample of ZIP code areas covering about 25% of Original Medicare Part B beneficiaries and follows the Medicaid-focused GENEROUS model, under which 40 states and Puerto Rico have already agreed to similar international benchmarking for Medicaid drug pricing.
- Industry
KFF Health News Minute Roundup Covers Medicaid Meal Pilots, Work Rules
KFF Health News publishes weekly "KFF Health News Minute" audio digests summarizing original health policy reporting. Recent episodes touch on Medicaid-relevant topics, including states piloting medically tailored meal delivery programs to reduce costs and improve outcomes, concerns from doctors about certifying patient exemptions under new Medicaid work requirements, and warnings that homeless enrollees will need to document work activity to retain coverage. The digest format compiles brief summaries of multiple unrelated health stories each week rather than reporting a single new policy action. No specific effective dates, agency actions, or regulatory changes are detailed in the segments themselves.
- Legal
Law Firm Assesses Six Months of CMS Home Health Enrollment Moratorium
In a client alert, Arnall Golden Gregory LLP reviews the first six months of CMS's enrollment moratorium on home health and hospice agencies, imposed in May 2026 under the agency's CRUSH anti-fraud initiative. The firm examines how the moratorium has affected provider enrollment, M&A transactions, and agency growth in the sector, addressing industry concerns raised when the policy was first announced. The analysis covers practical impacts on providers and investors navigating the enrollment freeze. No new CMS action is reported; the piece is a retrospective legal analysis of an existing policy.
- Federal Policy
CMS Updates MDS Coding Guidance, Discharge Rules Still Unclear
CMS has issued updates to the MDS 3.0 Resident Assessment Instrument manual that address a long-standing provider concern: documentation demands during state case-mix audits and medical reviews that are often additional or conflicting. Nursing home operators and industry observers describe the coding changes as a significant win for providers, though questions remain around discharge coding clarity. The updates are due to be implemented, though the source does not specify a firm effective date. Nursing facilities, Medicaid case-mix states, and auditors handling MDS-based reviews will need to adjust documentation and audit practices once the guidance takes effect.
- State Policy · NE
Nebraska Counties Route Opioid Settlement Funds to Regional Authorities
Nebraska counties receiving opioid settlement payments are increasingly directing those dollars to regional behavioral health authorities rather than managing substance abuse programs independently, according to the report. These authorities are seen as better equipped to administer treatment and prevention services than individual county governments. The trend reflects how localities are distributing a multi-year stream of settlement funds from opioid litigation. No specific timeline or dollar figures for the shift were detailed in the report.
- State Policy · WI
Milwaukee Free Clinic Braces for Surge of Uninsured Patients
Bread of Healing Clinic, which provides free and low-cost care to Milwaukee residents, is preparing for an increase in uninsured patients following changes to Medicaid eligibility. The clinic is asking the community for additional support to handle the anticipated demand. No specific timeline or dollar figures are given in the report, but the clinic frames the shift as a direct consequence of recent Medicaid policy changes affecting coverage access.
- Industry
Lawyers Warn AI Fraud Tools Lack Human Oversight in Hospice Audits
In a two-part investigative series, Hospice News reports that legal experts are raising concerns about insufficient human oversight in AI-driven hospice fraud enforcement. Attorneys Edo Banach (Foley Hoag) and Howard Young (Morgan Lewis) say CMS contractors are using AI tools to select hospices for audit and process rebuttals, sometimes producing responses with apparent AI "hallucinations" that get reversed once humans review them. CMS's proposed CRUSH initiative, along with AI-driven data mining by the FBI, HHS-OIG, and DOJ's National Fraud Detection Center, are scrutinizing billing anomalies like long lengths of stay and high recertification volumes, with recent revocations concentrated in Arizona, California, Nevada and Texas. CMS did not respond to requests for comment on its AI oversight practices.
- Industry
Elevance Moves to Curb Hospital Billing for Off-Campus Care
Elevance Health is implementing a policy to restrict hospitals from charging facility fees or higher reimbursement rates for services delivered at off-campus outpatient departments, aiming to align payment with site-neutral principles. Hospital groups oppose the move, arguing the reimbursement reductions could jeopardize patient access to care, particularly in markets where hospital-owned outpatient clinics are prevalent. The policy affects hospitals and health systems contracted with Elevance across its commercial and potentially Medicaid managed care lines. Details on effective dates and scope across Elevance's state Medicaid contracts were not specified.
- Industry · OR
Oregon Candidate Beck Makes Rural Medicaid Cuts Campaign Issue
Democrat Chris Beck, challenging Republican Rep. Cliff Bentz in Oregon's 2nd Congressional District, is campaigning on protecting rural health care from Medicaid cuts included in the 2025 federal tax and spending law (H.R. 1). Beck argues the law, which Bentz supported, could cause rural hospitals to lose Medicaid reimbursements as patients lose coverage, calling it a potential "financial death knell" for rural facilities. He is calling for repeal of the law and voiced support for a national health system modeled on the Oregon Health Plan that would guarantee basic and preventive care. Bentz did not respond to an interview request; the race is ongoing ahead of the 2026 election.
- Federal Policy
CMS Finalizes Scaled-Back Medicare Drug Pricing Pilot
The Trump administration finalized the GLOBE rule, a mandatory pilot aimed at lowering Medicare prices for physician-administered drugs by benchmarking them to prices in other wealthy countries. The final version applies to only four drug companies, a steep reduction from the scope of the initial proposal, and excludes companies that already struck voluntary most-favored-nation pricing deals covering Medicaid drugs. A related mandatory pilot, GUARD, remains at the proposed-rule stage. The narrowed scope significantly limits projected savings compared to the original proposal.
- Legal · WI
Judge Strikes Down Trump Rule Requiring Immigration Checks for Federal Services
A federal judge ruled Sept. 21 that the Trump administration's 2025 rule requiring immigration status checks for users of federally funded adult education, Head Start, and community health centers violated notice-and-comment requirements. The rule would have barred undocumented immigrants and several legal-status categories, including TPS holders and U visa applicants, from these programs, reversing a three-decade interpretation that such safety-net services were open to all regardless of immigration status. Wisconsin and 20 other states had sued to block the rule, arguing it would force states to restructure social safety nets and render them inaccessible to vulnerable residents. The ruling permanently blocks enforcement of this version of the rule, though federal agencies could reissue it after proper notice and comment.
- Legal · IA
Former Public Defender Sentenced for Medicaid Fraud Scheme
A former public defender and Iowa-licensed attorney, Cassi Wigington, has been sentenced to five months in prison for healthcare fraud. A federal grand jury in Nebraska charged her in June after prosecutors alleged that, beginning in 2012, she fraudulently sold medical equipment including custom-made breast prosthetic devices to cancer patients and billed Medicaid for the scheme. The case was prosecuted in federal court, and the sentencing closes out the criminal proceedings against her.
- State Policy · ND
North Dakota Shifts Rural Health Grant Management to Anchor Partners
North Dakota's Health and Human Services Department is shifting from directly managing all 500-700 grants under its Rural Health Transformation Program funding to using outside "anchor partners," in-state organizations that will handle grant applications and individual grant management while HHS oversees at a higher level. North Dakota had been the only state managing every grant itself; three anchor partners are being used, including the University of North Dakota Center for Rural Health, with two more still to be finalized. The change comes as more than $161 million of the state's $199 million award remains unawarded ahead of an October 30 deadline, prompting lawmaker concerns about transparency, selection criteria, and further delays. CMS is expected to announce North Dakota's second-year funding amount, estimated near $200 million, in October.
- Industry · MA
Out-of-State Chains' Nursing Home Buyouts Tied to Quality Declines in Mass.
Citing a Boston Globe Spotlight investigation, Skilled Nursing News reports that out-of-state chains have rapidly acquired Massachusetts nursing homes since 2020, with nine New York and New Jersey-based chains growing their holdings from 12 facilities in 2019 to 61 by 2025, about one-fifth of the state's nursing homes. Eight of the nine chains saw average federal star ratings decline after acquisition, driven by cost-cutting that slashed nursing hours while shifting payments to owner-affiliated companies. RegalCare, led by CEO Eli Mirlis, is highlighted as a case study: facilities fell from 5-star to 1-star ratings within three years as rent and related-party payments rose even as nursing spending fell. The Globe found Massachusetts regulators have not denied an acquisition application or revoked a license in seven years, though a recent law now lets them weigh an operator's out-of-state record.
- Industry · NJ
NJ Behavioral Health Nonprofit CBH Care Files Chapter 11 Bankruptcy
Hackensack, New Jersey-based Comprehensive Behavioral Health Care Inc. (CBH Care) has filed for Chapter 11 bankruptcy protection, citing a prolonged landlord dispute over its main facility that began with HVAC failures in 2018 and escalated to an eviction motion in June 2026. The nonprofit, which derives about 45% of revenue from government grants and a substantial portion of the remainder from Medicaid reimbursements, says litigation costs and building habitability problems strained its already thin margins. CBH Care operates 20 locations across Northern New Jersey offering outpatient mental health, crisis care, residential and supported living programs, employing roughly 350 staff. Its five-week cash budget shows about $2.7 million in revenue and disbursements during the bankruptcy process.