- CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- Public Inspection: CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Public Inspection: HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Increased Risk of Cyber Threats Against Healthcare and Public Health Sector
- HRSA Announces Action to Lower Out-of-Pocket Costs for Life-Saving Medications at Health Centers Nationwide
- Announcing the 2030 Census Disclosure Avoidance Research Program
- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
CMS Limits Certain Medicaid Demonstration Authorities
The Centers for Medicare & Medicaid Services (CMS) informed states that it does not anticipate approving new or existing Section 1115 Demonstrations that expand continuous eligibility or test workforce initiatives.
Under federal regulations, states generally must redetermine a beneficiary’s eligibility once every 12 months. Using Section 1115 waivers, states were allowed to expand continuous eligibility – increasing the length of time that individuals could stay enrolled in Medicaid or CHIP, instead of proving their eligibility annually. States also used these waivers to test initiatives to expand the health workforce, such as student loan repayment and workforce training programs to recruit and retain providers, through the Medicaid program.
States with currently approved Section 1115 waivers for expanded continuous eligibility must notify beneficiaries about any changes to their current period of continuous eligibility and when the beneficiary will need to undergo their next redetermination. CMS will allow currently approved workforce initiatives in California, Massachusetts, New York, North Carolina, and Vermont to run their course.
Revised Interpretation of “Federal Public Benefit” Announced
The U.S. Department of Health and Human Services (HHS) issued a Federal Register Notice that revises the 1998 interpretation of the term “Federal public benefit” as used in Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). Read the Federal Register Notice.
The notice establishing this revised policy interpretation takes effect immediately upon publication in the Federal Register and has a 30-day comment period that ends at 11:59 p.m. ET on Wednesday, August 13, 2025.
See the HHS press release.
Interstate Occupational Licensure Arrangements to Expand Access to Behavioral Health Services.
This policy brief from the WWAMI Rural Health Research Center describes state-based provisions to expand behavioral health services through interstate licensure arrangements for psychologists, social workers, licensed professional counselors, marriage and family therapists, and school psychologists, including licensure compact agreements and licensure portability models.
Read the report: Interstate Occupational Licensure Arrangements to Expand Access to Behavioral Health Services.
Report: 80% of US Counties Contain ‘Health Care Deserts’
According to new research from health care and prescription price-comparison website GoodRx, 81 percent of U.S. counties, home to more than 120 million Americans, fall under the definition of ‘health care desert’ in some way. This includes those that lack proper access to either pharmacies, primary care, hospital beds, trauma centers or community health centers.
Dr. Oz’s Second-in-Command Explains Need for Medicaid Reimbursement Cuts as “Big Beautiful Bill” Passes
President Trump signed the “One Big Beautiful Bill Act” into law on July 4 and now leaders such as Stephanie Carlton are in charge of implementing it.
She’s the deputy administrator and chief of staff at the Centers for Medicare & Medicaid Services. Carlton and the administration see the law’s benefits because Medicaid reimbursement rates “were allowed to go up to commercial rates and states are at varying levels towards that cap”. Carlton then acknowledged these are providers who are committing to society and to Americans in need that they’re going to help with their healthcare needs. And continued “but paying up to commercial rates kind of changes the focus of the program, where it becomes more about facilities profiting more than making sure patients are taken good care of.”
Representatives Reintroduce 340B PATIENTS Act in Congress
Congresswoman Doris Matsui (D-CA) and Senator Peter Welch (D-VT) introduced the 340B PATIENTS Act, legislation that would protect and strengthen the 340B program by codifying 340B providers’ ability to use contract pharmacies to dispense 340B discounted drugs. This would ensure that 340B patients are able to pick up their prescriptions at any local pharmacy, and that safety-net providers are able to continue providing expanded medical and social services to their communities using their 340B discount savings.
Pharmacies Are Disappearing Across Pennsylvania; Operators Blame Broken Payment System
“Hundreds of pharmacies across Pennsylvania have gone out of business in recent years, data obtained by Spotlight PA show, and pharmacists say legislation passed last year to help isn’t doing enough to stave off more closures.”
Click here for the full article.
New Pennsylvania Cardiac Procedures Report Released
The Pennsylvania Health Care Cost Containment Council’s (PHC4) Cardiac Procedures Report, displays results for six cardiac procedures performed in Pennsylvania acute care hospitals from January 1, 2022, through December 31, 2023. This report displays hospital-specific ratings for in-hospital mortality, readmissions, extended postoperative length of stay, volume of cases, and average hospital charges.
Barry D. Buckingham, PHC4’s Executive Director, strives to ensure PHC4’s reporting continuously brings value to the stakeholders it supports. “Providing as much insight as possible empowers professionals and patients in Pennsylvania with fact-based information to make informed decisions, which is at the core of our mission at PHC4.” Buckingham went on to state that PHC4 aims to go on supporting Pennsylvanians by continuously enriching its publicly available, fact-based, health care reporting.
The six procedure types reported in the Cardiac Procedures Report are coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) with and without a heart attack, surgical aortic valve replacement (SAVR), SAVR with CABG, and transcatheter aortic valve replacement (TAVR). Also included for these procedure types is data displaying statewide Medicare payments. Visualizations also offer insight within the Cardiac Procedures Report, like the graph below showing changes in the volume of cases from 2019 to 2023.
PHC4 is an independent council formed under Pennsylvania statute (Act 89 of 1986, as amended by Act 15 of 2020) in order to address rapidly growing health care costs. PHC4 continues to produce comparative information about the most efficient and effective health care to individual consumers and group purchasers of health services. In addition, PHC4 produces information used to identify opportunities to contain costs and improve the quality of care delivered.
For more information, visit phc4.org or review the full report here.
Introducing CDC-Funded Healthy Nonprofit Network for Community-Based Organizations
Is your nonprofit organization prepared for the rest of 2025 and beyond? Join the Healthy Nonprofit Network (HNN) – a new initiative created to support small, rural, and southern nonprofits working to build healthier communities.
The CDC-funded HNN is part of the Emory Centers for Public Health Training and Technical Assistance at Emory University’s Rollins School of Public Health. The network helps community-based organizations thrive by providing essential training and support for organizational sustainability. HNN offers education, comprehensive assessment, training, and coaching in the following focus areas:
- Organizational development and process improvement
- Workforce development
- Partnership development and engagement
The HNN is national in scope but offers free services to all health-focused community-based organizations, with a special focus on small organizations serving rural areas in under-resourced communities. These services span across all public health issues, risk factors, and professional competencies.
Learn how to join here: https://healthyorgs.org/healthy-nonprofit-network-launch-webinar-on-demand/.
Report Highlights the Hidden Costs of Tooth Decay
Cavities aren’t just a bother—tooth decay is the most common chronic disease among children and adults, and it’s taking a painful toll on families across Pennsylvania. Check out the latest article from PCOH, “Tooth Decay is a Disease – And It’s Hurting Pennsylvania Families.”