The Centers for Medicare and Medicaid Services sent guidance to State Health Officials on how states can best implement the continuum of care for crisis services through Medicaid and the Children’s Health Insurance Program (CHIP). According to the agency, the guidance was developed in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA) as well as healthcare providers… (Marceno, September 8, 2025) #Care Coordination, #Mental and Behavioral Health, #Opioids, #Public Health

Today, the Medicare Payment Advisory Committee (MedPAC) convened a session on the impact of changes in Medicare Advantage (MA) enrollment on hospital finances. In their assessment, staff found that increases in MA enrollment are not associated with a statistically significant change in hospital profit margins but are associated with lower hospital revenues and costs, although the effect may differ for hospitals affiliated with… (McClurg, September 5, 2025) #Hospitals, #Medicare Advantage

The Medicare Payment Advisory Committee (MedPAC) convened a session to discuss a draft of the Commission’s context chapter on Medicare payment policy and financing. Principal Policy Analyst Rachel Burton and Policy Analyst Alexandra Harris detailed that the chapter serves as the backdrop for MedPAC discussions and recommendations over the coming year, featuring information on Medicare spending trends, drivers of Medicare’s… (Eisen, September 5, 2025) #Medicare Advantage, #Medicare Part D, #Physicians

The Federal Trade Commission (FTC) issued a request for information (RFI) to examine the use and impact of employer noncompete agreements and to help shape potential future enforcement actions (press release). The FTC detailed evidence showing that noncompete agreements can lead to reduced job mobility, suppression of wages, limited innovation, and harm to competition. The agency rejected the previous administration’s… (Eisen, September 4, 2025) #Workforce

The Centers for Medicare and Medicaid Services (CMS) announced a prior authorization demonstration program for certain ambulatory surgical center (ASC) services. CMS says that prior authorization ensures that services comply with applicable Medicare coverage, coding, and payment rules before services are rendered or claims are submitted. CMS believes that this demonstration will protect the Medicare Trust Fund from improper payments and ensure that… (McClurg, September 4, 2025) #Ambulatory Surgical Centers, #Demonstration Programs, #Program Integrity

The Department of Health and Human Services (HHS), through the Office of the Inspector General (OIG) and Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), announced that it will increase resources to address the practice of information blocking. HHS will be taking active enforcement against entities that restrict patient engagement in their own care by blocking… (McClurg, September 3, 2025) #Health Information Technology

Today, the Center for Medicare and Medicaid Innovation (CMMI) announced a set of policy and operational changes to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model and extended all cohorts through 2035 (announcement; updated FAQs, model website). The model’s acronym, created by the Biden Administration, originally stood for States Advancing All-Payer Health Equity Approaches and Development. Key changes are described below: Model-wide… (Testa, September 2, 2025) #Delivery Reform, #Demonstration Programs, #Primary Care

The Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicaid and the Children’s Health Insurance Program (CHIP) from May 2025. The points below reflect the key findings. Medicaid and CHIP – As of May 2025, 78.1 million people are enrolled in Medicaid and CHIP. 70.8 million are enrolled in Medicaid and 7.3 million are enrolled in CHIP. In total,… (Marceno, August 29, 2025) #Insurance Coverage, #Public Health

The Centers for Medicare and Medicaid Services (CMS) recently released the performance year (PY) 2024 financial and quality results of Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). ACO-specific metrics are available here. In the fact sheet, CMS reiterates the Trump Administration’s commitment to ensuring participation in MSSP, noting that the program aligns with HHS Secretary Kennedy’s “Make American Healthy… (Llamas, August 29, 2025) #Accountable Care Organizations

The Health Resources and Services Administration (HRSA) launched a new public dashboard to track when organ transplants occur outside of the standard list of matched patients. The organ transplant system matches donor organs with patients based on urgency, distance, and other rules to ensure fairness. Allocation out of sequence (AOOS) happens when a transplant is offered, accepted, or transplanted outside of the expected order. HRSA… (McClurg, August 27, 2025) #Program Integrity, #Transparency