Tag: CMS

MHA Monday Report Jan. 26, 2026

Member News, Monday Report

House Appropriations Committee Hears RHTP Testimony, IMLC Bill Advances

The Michigan House Appropriations Committee heard testimony on federal funding awarded through the Rural Health Transformation Program (RHTP), and legislation to add Michigan back into the Interstate Medical Licensure Compact (IMLC) advanced during the week of Jan. 19.  The House Appropriations Committee heard …

Legislative Policy Panel Hears Legislative Updates

The MHA Legislative Policy Panel met virtually Jan. 21 to develop recommendations on legislative and policy issues impacting Michigan hospitals. The meeting began with guest speakers from the Michigan Chamber of Commerce and The Cornerstone …

CMS Implements New Online Form for Medicare Advantage Complaints

The Centers for Medicare & Medicaid Services (CMS) recently implemented a new online form for providers to submit complaints related to Medicare Advantage plans. A CMS memorandum announced the implementation of the form, which is …

MHA Launches Rural Health Transformation Program Webpage

The MHA has launched a new webpage dedicated to the Rural Health Transformation Program, providing members with a centralized source of information on Michigan’s participation in the program. The webpage includes an overview of …

Updates to Michigan’s Reporter Protocols for Infants Born Exposed to Substances

Michigan has updated its mandated reporter guidance for infants born exposed to substances, establishing distinct reporting requirements for exposure to non-medically prescribed substances and exposure related to prescribed treatment. The updates are intended to clarify …

Webinar Explores Strategies to Strengthen Revenue Integrity

The MHA and MHA Endorsed Business Partner AMN Healthcare Revenue Cycle Solutions will host A Tale of Three Health Systems: Their Mid-Revenue Cycle Insights and Road to Revenue Integrity webinar from 11 to 11:50 …

Hospitals Help: Corewell Health Program Addresses Youth Vaping Prevention, Cessation

Rural schools in Newaygo County, like so many across Michigan, were seeing an increase in the number of students caught vaping. To address this community-wide concern, Corewell Health Gerber Hospital established the Corewell Health Gerber …

Keckley Report

CMS’ 2024 Health Spending Report: Key Insights

“As media attention focused on Minneapolis, Greenland and Venezuela last week, the Center for Medicaid & Medicare Services (CMS) released its 2024 Health Expenditures report Thursday: the headline was “Health care spending in the US reached $5.3 trillion and increased 7.2% in 2024, similar to growth of 7.4% in 2023, as increased demand for health care influenced this two-year trend. “…

The current environment for the healthcare economy is increasingly hostile to the status quo. Voters think the system is wasteful, needlessly complicated and profitable. Lawmakers think it’s no man’s land for substantive change, defaulting to price transparency, increased competition and state regulation in response. Private employers, who’ve bear the brunt of the system’s ineffectiveness, are timid and reformers are impractical about the role of private capital in the health economy’s financing.

The healthcare economy will be an issue in Campaign 2026 not because aggregate spending increased 7-8% in 2025 per CMS, but because it’s no longer justifiable to a majority of Americans for whom it’s simply not affordable. Regrettably, as noted in Corporate Board Member’s director surveys, only one in five healthcare Boards is doing scenario planning with this possibility in mind.

Paul Keckley, Jan. 18, 2026

New to KnowNews to Know

  • The MHA Person & Family Engagement Advisory Council met virtually Jan. 15 to identify ways to support the MHA strategic action plan.
  • MHA Endorsed Business Partner CyberForce|Q is hosting the webinar Proactive Cyber Risk Measures from 11 a.m. to noon ET on Jan. 29.
  • The enrollment deadline for the MHA Healthcare Leadership Academy is Feb. 6. The cohort meets Feb. 25–27 and May 7–8 at the MHA headquarters in Okemos.

 

MHA Launches Rural Health Transformation Program Webpage

Member News, Rural Health Updates

The MHA has launched a new webpage dedicated to the Rural Health Transformation Program (RHTP), providing members with a centralized source of information on Michigan’s participation in the program. The webpage includes an overview of the state’s award, key focus areas, implementation timelines and details on how the program is expected to support long-term changes in rural healthcare delivery.

Members may use the webpage as a resource to better understand the scope of the RHTP and what to expect from the Michigan Department of Health and Human Services and the Centers for Medicare & Medicaid Services as additional guidance and funding opportunities are released. The MHA will continue to update the webpage as new information becomes available.

Members with questions may contact Lauren LaPine-Ray at the MHA.

CMS Implements New Online Form for Medicare Advantage Complaints

Member News

The Centers for Medicare & Medicaid Services (CMS) recently implemented a new online form for providers to submit complaints related Medicare Advantage (MA) plans.

A CMS memorandum announced the implementation of the form, which is now live and available to providers. The online form collects information about the complainant, beneficiary, provider and the MA plan involved. Providers are also prompted to submit a complaint summary, with optional fields for service dates and claim numbers.

Once a complaint has been submitted via the online form, it will be placed in a queue in the Health Plan Management System Complaints Tracking Module for review and triage. CMS will continue to serve as an arbitrator, working to facilitate resolution between the MA plan and the provider.

The MHA encourages members to use this form when experiencing issues related to MA claims.

Members with questions may contact Megan Blue at the MHA.

MHA Monday Report Dec. 22, 2025

Member News, Monday Report

Healthcare Bills Advance During Final State Legislative Session Week of 2025

Enforcement of hospital price transparency measures, removal of mental health questions on health professionals’ license applications, and the creation of a palliative care advisory task force were among the healthcare-related bills that advanced in the …

State’s Chief Medical Executive Shares Standing Recommendation Regarding Children’s Vaccines

Michigan’s Chief Medical Executive Natasha Bagdasarian, MD, issued a standing recommendation Dec. 18, encouraging healthcare providers to follow the children’s immunization schedules developed by the American Academy of Pediatrics or the American Academy of …

CMS Announces MAHA ELEVATE Model

The Centers for Medicare & Medicaid Services (CMS) is inviting healthcare organizations nationwide to apply for the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-Based Approaches Through Evidence (MAHA ELEVATE) model, a new initiative scheduled …

AHA Releases 2025 National Governance Report

The American Hospital Association (AHA) has released its 2025 National Governance Report. The report, based on data collected from August to December 2024, continues to develop a comprehensive picture of the state of healthcare…

Hospitals Help: Aspire Rural Health System Offers Lifeline to Families in the Thumb

Transitions, offered through Aspire Rural Health System, is a free community-based program dedicated to supporting individuals with chronic or life-limiting illnesses, as well as their families, across Michigan’s thumb region. The program provides a compassionate …

Mid-Program Year Highlights: Resources & Reports

Below is a compilation of resources shared during the first half of the 2025-26 program year to provide members with relevant tools, updates and insights.

Michigan Hospital Collaboratives Launch to Improve Community Health

More than 50 Michigan hospitals are coming together to improve outcomes in maternal health, behavioral health and chronic disease across the state through new community benefit collaboratives launched by the Michigan Health & Hospital Association …

MHA Keystone Center Annual Report Highlights Safety and Quality Initiatives

The MHA Keystone Center recently released its 2024-25 annual report, which demonstrates Michigan hospitals’ commitment to improving outcomes and advancing care. The report highlights MHA Keystone Center-led safety and quality initiatives, including: A five-year collaboration with …

Report: Access, Affordability & Community Health Improved by Hospital Programming, Investments

The MHA released its 2025 Community Impact Report highlighting community programming and investments from Michigan hospitals that are improving access to care, addressing affordability and advancing the health of …

New MHA Infographic Showcases Rural Michigan Healthcare Impact

The MHA recently released the infographic Healthcare Impact in Rural Michigan, which highlights how critical access hospitals, sole community hospitals, rural emergency hospitals and birthing hospitals support communities across the state. The infographic highlights the …

2025 Michigan Caregiver Navigation Toolkit Available

In alignment with National Caregiver Month, the MHA Keystone Center recently created the 2025 Michigan Caregiver Navigation Toolkit to support hospitals in their efforts to initiate and enhance caregiver support programming across the state. …

News to Know

  • The MHA will offer the Healthcare Leadership Academy in 2026, with cohorts meeting Feb. 25–27 and May 7–8 at the MHA Headquarters in Okemos.
  • MHA Endorsed Business Partner CyberForce|Q is hosting the Proactive Cyber Risk Measures Webinar on Jan. 29 with speakers from Trinity Health, the Michigan State Cyber Command Center and other organizations.
  • The MHA offices will be closed and no formal meetings will be scheduled Dec. 24, 2025–Jan. 1, 2026.
  • Due to the holidays, Monday Report will not be published Dec. 29 and Jan. 5 and will resume its normal schedule Jan. 12.

CMS Announces MAHA ELEVATE Model

Member News

The Centers for Medicare & Medicaid Services (CMS) is inviting healthcare organizations nationwide to apply for the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-Based Approaches Through Evidence (MAHA ELEVATE) model, a new initiative scheduled to launch in 2026.

MAHA ELEVATE will support the implementation of evidence-based lifestyle and chronic disease prevention programs aimed at improving outcomes for Medicare beneficiaries. The model will focus on interventions that address risk factors such as poor nutrition, physical inactivity, obesity, hypertension and diabetes, and will test whether preventive, lifestyle-oriented strategies can improve outcomes and reduce long-term healthcare costs when implemented at scale.

CMS will release a Notice of Funding Opportunity in early 2026 for the first cohort, and the voluntary model will launch Sept. 1, 2026. Funding will be awarded to organizations that propose interventions supported by strong evidence and demonstrate the ability to measure outcomes, report data and sustain program delivery over time. Proposals will be competitively reviewed based on evidence strength, implementation readiness and potential impact on Medicare populations.

Members interested in applying can find additional details, application materials and timelines on the CMS Innovation Center website.

Members with questions may contact the MHA policy team.

MHA Monday Report Dec. 8, 2025

Monday Report, Member News

Stop the Bleed Legislation Advances, Preadmission Screening Bill Introduced

Legislation protecting good Samaritans who apply bleeding-control techniques passed the Senate Civil Rights, Judiciary and Public Safety Committee, while a bill modifying timeline requirements for preadmission screening assessments of Medicaid patients was introduced during the …

CMS Releases 2026 Home Health PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule updating the home health prospective payment system (PPS) for calendar year 2026. Highlights of the rule include: An updated 30-day …

MDHHS Launches RHTP Listserv to Share Program Updates

The Michigan Department of Health and Human Services (MDHHS) recently launched a Rural Health Transformation Program (RHTP) listserv to provide timely updates, announcements and resources related to the state’s implementation of the program. Hospitals, health …

Health Access & Community Impact Office Hours Launch

The MHA Health Access & Community Impact Office Hours series kicked off Nov. 24 with a session highlighting 211 and its role in addressing food access amid ongoing challenges related to food insecurity. Sarah Kile, …

Nominations Open for 2026 Michigan Hometown Health Hero Awards

The Michigan Public Health Week Partnership, a coalition of 13 statewide organizations that include the MHA, is seeking nominations by Friday, Dec. 19, for individuals and organizations that have contributed to improving the health and …

MHA Rounds graphic of Brian PetersMHA CEO Report — Dedicated to Care Every Day of the Year

During the holiday season, we look forward to annual traditions and time spent with loved ones. While many of us gather around our tables this season, we are all aware of individuals who sacrifice this special time …

Centering Lived Experiences to Improve Maternal Care: Reflections from the Birth Experience Project

Over the past year, I supported the Birth Experience Project, a mixed-methods study examining how Black women across Michigan experience pregnancy, labor and delivery, and postpartum care. As part of this effort, I assisted in analyzing …

Keckley Report

The 10 Healthcare Headlines you Might See in 2026

“2026 is a mid-term election year. In 2016 (Trump 45 Year One), Republicans controlled 31 governorships and 68 legislative chambers. This January, the GOP will control 26 governorships and 57 legislative chambers– a 15% reduction on both. Politics is divided, affordability matters most to voters and healthcare is a high-profile target for campaigns so humility, thoughtful messaging backed by demonstrable actions will be an imperative for every healthcare organization.

2026 is a HUGE year for U.S. healthcare. The outcome is unknown.”

Paul Keckley, Nov. 23, 2025

CMS Releases 2026 Home Health PPS Final Rule

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule updating the home health (HH) prospective payment system (PPS) for calendar year (CY) 2026.

Highlights of the rule include:

  • An updated 30-day episode payment rate of $2,038.22, comprised of a net 2.4% market basket update, a 3.6% reduction due to budget neutrality requirements of the Patient-Driven Groupings Model (PDGM) and other budget neutrality adjustments. The 2026 rate is down 0.1% from the current $2,057.35. Providers who fail to submit quality data are subject to an additional two percentage point reduction.
  • A fixed-dollar loss ratio of 0.37, up from 0.35, with the CMS maintaining the existing 0.8 loss-sharing ratio.
  • Recalibrated PDGM case mix weights based on CY 2024 data; updated low-utilization payment adjustment thresholds, updated functional impairment levels and comorbidity adjustment subgroups.
  • Modifying the face-to-face encounter restriction to allow physicians and non-physician practitioners to perform the face-to-face encounter, regardless of whether they are the certifying physician or previously cared for the patient.
  • Updating the HH quality reporting program (QRP) to remove the measure that assesses the percentage of patients receiving COVID-19 vaccinations and the corresponding outcome and assessment information set data element. The CMS is also removing four patient assessment data elements related to social drivers of health from the HH QRP. These measures include one living situation item, two food items and one utilities item.
  • Adding four new measures to the HH value-based purchasing program, Medicare Spending per Beneficiary, and three measures assessing patient functional improvement in dressing and bathing.
  • Adopting several new and revised provider enrollment provisions that the CMS believes will help reduce improper Medicare payments and protect beneficiaries.

The MHA will provide members with an updated impact analysis in the next several weeks. Members with questions should contact Vickie Kunz at the MHA.

CMS Releases CY 2026 Physician Fee Schedule Final Rule

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the physician fee schedule for calendar year (CY) 2026.

Highlights of the final rule include:

  • Implementing the one-time 2.5% statutory increase included in H.R. 1.
  • Establishing two separate conversion factors: one for qualifying alternative payment model participants (QP) and another for non-qualifying physicians and practitioners.
    • The QP conversion factor would increase by 3.8% to $33.58.
    • The non-QP conversion factor would increase by 3.3% to $33.40.
  • Modifying several telehealth waivers, including:
    • Permanently removing the frequency limitations for subsequent inpatient visits, nursing facility visits and critical care consultations.
    • Permanently adopting a definition of direct supervision to include virtual presence via audio/video real-time communications technology.
    • Permanently allow teaching physicians to have a virtual presence for services involving residents across all training locations when the service is performed virtually.
    • Extending the ability for federally qualified health centers and rural health clinics to bill telehealth services through Dec. 31, 2026.
  • Enhancing integration of behavioral health into primary care by:
    • Clarifying that marriage and family therapists, and mental health counselors, can bill Medicare directly for community health integration and principal illness navigation services.
    • Creating add-on codes for advanced primary care management services that complement previously established Behavioral Health Integration or psychiatric Collaborative Care Model services.
    • Retaining the Healthcare Common Procedure Coding System code that describes social determinants of health risk assessment and revising its descriptor to refer to “upstream drivers” of health rather than “social determinants.”
  • Creating a new claims-based methodology to remove units of drugs purchased under the 340B program for purposes of calculating Medicare drug inflation rebates starting Jan. 1, 2026. The claims-based methodology uses existing data files for these linkages and does not require 340B-covered entities to submit any additional data. The CMS also finalized its proposal to create a 340B claims data repository, allowing voluntary data submission by 340B providers for potential use in the same purpose.
  • Implementing the Ambulatory Specialty Model, a mandatory alternative payment model within selected core-based statistical areas, focused on specialists who care for beneficiaries with heart failure and low back pain, to begin Jan. 1, 2027, and run for five years through Dec. 31, 2031.
  • Establishing a merit-based incentive payment system (MIPS) performance threshold of 75 points for the 2026 performance period through the 2028 performance period, while also adopting six new MIPS Value Pathways (MVPs) and modifying performance categories under the Quality Payment Program. The new MVPs are for:
    • Diagnostic radiology
    • Interventional radiology
    • Neuropsychology
    • Pathology
    • Podiatry
    • Vascular surgery

The MHA will provide an updated impact analysis in the coming weeks. Members with questions should contact Vickie Kunz at the MHA.

MHA Monday Report Oct. 27, 2025

Monday Report, Member News

Speech-Language Pathologist Medicaid Coverage and Critical Incident Stress Management Services Legislation Advances

Legislation improving coverage policies for speech-language pathologists and broadening those included under Critical Incident Stress Management services advanced in the Michigan House of Representatives during the week of Oct. 20. House Bill …

CMS Releases Updated Guidance During Federal Government Shutdown

The Centers for Medicare & Medicaid Services (CMS) recently instructed all Medicare Administrative Contractors to lift the hold and begin processing fee-for-service claims dated Oct. 1 and after. The action follows the hold on …

Webinar to Review MHA 2025-26 Strategic Action Plan

The MHA will host a virtual member forum from 8:30 to 9:30 a.m. Nov. 7 to outline the MHA 2025-26 Strategic Action Plan (SAP) approved by the MHA Board of Trustees. The 2025-26 SAP maintains …

MHASC Board Engages in Strategic Planning Retreat

The MHA Service Corporation (MHASC) board met Oct. 21 to discuss healthcare market strategies to identify, diversify and grow solutions for MHA members and clients. The board’s strategic planning retreat focused on creative ideation and …

MHA Hosts Conversation on Strengthening Michigan’s Healthcare Workforce

The MHA convened more than 90 individuals on Oct. 16 for a Healthcare Careers Conversation event. Human resources professionals, clinical leaders, education and workforce partners gathered to explore ideas for growing the healthcare pipeline. As part …

MHA Shares Recent Medicare and Medicaid Enrollment Analysis

The MHA recently updated its analysis of Medicaid and Medicare enrollment based on September 2025 data. The analysis includes program enrollment as a percentage of each county’s total population and the split between fee-for-service and …

Strengthening Health Literacy Through Better Communication

In healthcare, words can be as powerful as medicine. A patient’s ability to understand their diagnosis, treatment options or discharge instructions can directly influence their recovery and long-term health. Yet too often, communication between clinical experts …

Keckley Report

Will Healthcare’s Big Tents Pivot?

“As the federal government shutdown enters its third week, U.S. healthcare is in the crosshairs.

The federal government U.S. spent 27% of its total spending on healthcare last year and projects to spend at least 5.5% more every year through 2035. In that period, it will grow from 18% of the U.S. GDP to 21%. It’s labor intense, capital intense, fragmented, highly regulated and high profile. Its growth is the result of increased demand, clinical and technologic innovations and higher unit prices for hospital care, specialty drugs and insurance premium increases. Thus, when the U.S. economy is doing well, healthcare does even better. And when the U.S. economy slumps, it does well producing job growth and earnings above peer industries.

Healthcare spending is not insulated from broader economic forces requiring messaging by ‘Big Four’ and by each member to be more clear, more accurate and less misleading. The big question each must ask Members and Boards is this: ‘are we prepared to pivot from the status quo to a better system of health might require uncomfortable changes necessary to serve the greater good?

The erosion of public trust and confidence in our political system is instructive. Healthcare can (and must) do better.

That effort is urgently needed. The Big Four should take the lead together!”

Paul Keckley, Oct. 19, 2025

MHA in the News

The Detroit Free Press published an op-ed Oct. 21 from MHA CEO Brian Peters that affirms the commitment of hospitals to patients and shares the actions hospitals are taking to keep costs low for patients. …

CMS Releases Updated Guidance During Federal Government Shutdown

Member News

The Centers for Medicare & Medicaid Services (CMS) recently instructed all Medicare Administrative Contractors (MACs) to lift the hold and begin processing fee-for-service claims dated Oct. 1 and after. The action follows the hold on services impacted by select expired Medicare legislative payment provisions, including those paid under the Medicare physician fee schedule, ground ambulance transport claims and Federally Qualified Health Center claims.

The updated guidance also instructs MACs to process telehealth claims that the CMS can confirm are for behavioral and mental health services. The CMS directed all MACs to continue holding claims for other telehealth services (non-behavioral/mental health claims) due to the Sept. 30 expiration of telehealth flexibilities put in place during the COVID-19 public health emergency and for the acute Hospital Care at Home Program, which also expired Sept. 30.

CMS also released an updated FAQ document Oct. 15 to provide additional guidance to providers.

Members with questions may contact Vickie Kunz at the MHA.