Big Beautiful Bill Update
Another update on the Big Beautfiul Bill as it seeks to work its way through the Senate. A number of major developments today.
A new brief from America’s Essential Hospitals says the Medicaid reductions could mean an increase in hospital uncompensated care of $42.4 billion.
The Paragon Health Institute, a conservative think tank with major influence in the administration, is urging the Senate to make changes in the bill to go deeper in terms of cuts and reform.
It says lawmakers should make changes in the following areas:
- All state directed payments under Medicaid should be capped at Medicare rates rather than grandfathering in existing rates.
- It says the bill should go further than the limits on provider tax reform by phasing down provider taxes in only Medicaid expansion states.
- It wants limits on intergovernmental transfers, where local governments or public providers like county hospitals and university health systems send funds to the state to boost federal matching funds.
Republicans in the Senate are looking at making cuts in Medicare to offset Medicaid cuts or add to overall savings. The likely targets are Medicare Advantage (MA) plan risk adjustment upcoding as well as potentially site neutral payment reform. The Better Medicare Alliance opposes any reduction in MA. Paragon recommended Medicare reforms that could save $712 billion, including $250 billion in MA changes and another $220 billion in site-neutral reforms. Other savings could come from reforms to uncompensated care, the 340B program, and more.
In other news, Humana has recommended some changes to risk adjustment coding as well. It wants to place some restrictions on reimbursement for conditions reported during in-home visits (where health risk assessments (HRAs) are performed) and chart reviews. It says diagnoses from home-based HRAs should only be counted if reported by other providers. In addition, it says diagnoses from chart review submissions should only count if the original medical record is present unless reported by another provider. These changes are what I have been recommending too.
Additional articles: https://essentialhospitals.org/wp-content/uploads/2025/06/CBO-Analysis-Reconciliation-June-2025.pdf and https://www.fiercehealthcare.com/providers/one-big-beautiful-bill-would-raise-hospitals-uncompensated-care-costs-42b-2034 and https://insidehealthpolicy.com/daily-news/paragon-joins-push-senators-modify-house-reconciliation-bill and https://www.fiercehealthcare.com/payers/house-gop-advances-budget-megabill-imposing-stricter-medicaid-work-requirements and https://insidehealthpolicy.com/daily-news/bma-pushes-back-gop-senators-broach-ma-cuts-reconciliation-talks and https://thehill.com/homenews/senate/5334831-republican-senators-consider-medicare-changes/?tbref=hp and https://www.modernhealthcare.com/politics-policy/humana-medicare-advantage-billing-limits
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#budgetreconciliation #trump #congress #spending #medicaid #uninsured #coverage #medicare #medicareadvantage #riskadjustment #siteneutral
https://www.modernhealthcare.com/politics-policy/medicare-cuts-trump-tax-bill
— Marc S. Ryan
