Federal court vacates Medicare DSH rule affecting 2005-2013 payments
In a decision with implications for a larger case, a federal court on Aug. 28 vacated a 2023 rule that affected the calculation of Medicare disproportionate share hospital (DSH) payments retroactively over a nine-year period. As stated in a September 2025 ruling on the merits, the court found the rule to be unlawfully retroactive, as…
HFMA Comments on CY 2027 Hospital OPPS and ASC Proposed Rule
HFMA presents its comment letter to CMS on the CY 2027 Hospital OPPS and ASC Proposed Rule.
OMB federal grant rule delayed as Congress passes continuing resolution
The continuing resolution (CR) passed by both houses of Congress ensures the federal government will remain fully operational into December, and it also freezes implementation of a noteworthy change to grant-approval processes. Until the CR’s Dec. 11 expiration date, the Office of Management and Budget (OMB) is blocked from finalizing a previously proposed rule regarding…
Medicare Worksheet S-12 adds to cost-reporting demands for hospitals
Acute care hospitals are taking steps to incorporate a required new worksheet in their Medicare cost reporting. Effective for cost-reporting periods that end on or after Jan. 1, 2026, most hospitals paid under the Inpatient Prospective Payment System (IPPS) must fill out Worksheet S-12. An analysis by Baker Tilly notes that the worksheet is the…
CMS proposes faster Medicare coverage for breakthrough medical devices
Medicare coverage of some breakthrough medical devices would be accelerated under a Trump administration proposal released this month. CMS published an Aug. 11 notice of proposed processes that would include issuing an initial national coverage determination (NCD) simultaneously with FDA authorization of an eligible device and finalizing Medicare coverage within three months of authorization. As…
Medicaid state-directed payments for hospitals face cuts across 37 states under OBBBA
Hospital state-directed payments (SDPs) in at least 37 states are set to be reduced as part of Medicaid cutbacks in the One Big Beautiful Bill Act (OBBBA), according to a new analysis. Roughly $60 billion in current federal spending on hospital SDPs will come in above the OBBBA’s limits, set at 110% of the Medicare…
FY 2027 Final IPPS MS-DRG Rate Comparison to FY 2026 Rates
HFMA presents a spreadsheet comparing the FY 2027 IPPS final rule relative weights and standardized amounts with the final FY 2026 weights and rates.
CMS updates prior authorization transparency requirements for health plans
As part of efforts to improve prior authorization, CMS has bolstered its transparency requirements for health plans. Based on 2024 regulations that partially took effect in 2026 and are intended to promote electronic prior authorization, new requirements apply to health plans in Medicare Advantage (MA), Medicaid managed care and the Affordable Care Act marketplaces, along with state…
Leading without authority, with Dave Sanderson
Dave Sanderson, CEO of Resilience Partners Group, became a leader the day a routine flight he was on made history as the “Miracle on the Hudson.” Now, Sanderson, who spent much of his career in healthcare, coaches people on how they can choose leadership, even when they’re not in charge. Also in this episode, Nick…
Court decisions on ACA marketplace rules affect key coverage provisions
As CMS moves ahead with Medicaid funding limits for gender-affirming care in minors, Democratic state leaders used litigation to block restrictions in the Affordable Care Act (ACA) insurance marketplaces. The ACA policy, established in 2025 regulations, would remove the essential health benefit (EHB) designation from gender-affirming care. EHB status allows ACA consumer protections, such as…