Medicare & Medicaid Policy
Expert articles and analysis related to medicare & medicaid policy.
AI Summary — Last 7 Days
CMS payment-model policy is drawing sharper provider and congressional scrutiny: hospital groups and ACO stakeholders are pressing for changes to mandatory episode models—especially TEAM and the proposed CJR-X expansion—arguing that chronic inpatient underpayment, benchmarking, and quality-measure design could undermine participation and care redesign incentives (Premier comments). At the same time, Medicare Advantage prior authorization remains a flashpoint, with lawmakers moving to block CMS’ AI-enabled WISeR pilot and HHS OIG finding MA plans overturned nearly all appealed SNF admission denials, reinforcing concerns that utilization management may be delaying needed post-acute care and shifting burden onto providers and patients (Healthcare Dive). For VBC leaders, the week’s pattern is clear: the Trump administration’s CMS is pursuing model expansion and technology-enabled payment oversight, while providers, ACOs, and Congress are pushing for stronger guardrails on financial risk, care access, and administrative burden.
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