340B rebate model lawsuit seeks to halt 2027 rollout, citing hospital costs
Hospital advocates are seeking to stop the planned launch of a rebate model for the 340B Drug Pricing Program, filing litigation in the court that granted them relief on the same issue a year ago. The American Hospital Association (AHA), Maine Hospital Association (MHA) and four safety-net hospitals brought their lawsuit to Maine federal court,…
2027 Medicare Advantage Star Ratings show gains in high-rated plan enrollment
More than 70% of beneficiaries in Medicare Advantage (MA) plans that include prescription drug coverage are in contracts rated at least four stars out of five, according to CMS’s Star Rating release for 2027. Those plans are in line for quality-bonus payments and in 2028 will receive higher rebates that are used to support supplemental…
Hospital obstetric service closures grow as Congress considers responses
Amid deteriorating access to maternity care across the U.S., Congress is trying to find solutions, while recent data indicate how the situation is playing out at hospitals. A September 2026 report by the University of Minnesota’s Rural Health Research Center states that hospital-based obstetric services declined nationwide between 2010 and 2024, with 718 instances of…
FTC expands healthcare price transparency enforcement as HHS updates rules
Notable government actions on healthcare price transparency have taken place this week, with the Federal Trade Commission (FTC) opening a new front in enforcement of hospital price transparency and HHS updating regulations for health plans. Although hospital price transparency enforcement has primarily fallen under the purview of CMS, the FTC says breaches of transparency requirements…
340B rebate model takes shape for 2027 with 10 manufacturers, 21 drugs
The new rebate model for the 340B Drug Pricing Program took a step closer to implementation Oct. 1 with the announcement of the initial cohort of participating manufacturers and covered drugs. The Health Resources and Services Administration (HRSA) posted 10 manufacturers and 21 drugs that have been approved for the pilot, which is scheduled to…
Elevance Health brings commercial site-neutral payment to hospital claims
Elevance Health is moving site-neutral payment concepts into commercial reimbursement, with a Sept. 29 announcement setting the stage for constraints on hospital payment. The insurer said it would incorporate a series of new billing policies “intended to address increasingly common situations where care provided at an off-campus location is billed at a higher hospital rate.”…
Healthcare price transparency legislation hits a roadblock in the Senate
Despite widespread, bipartisan support, legislation expanding price transparency remains in limbo in the Senate as Congress considers healthcare policies for inclusion in a year-end package. The Senate seemed on track to pass the Patients Deserve Price Tags Act (S. 2355) on an accelerated basis Sept. 24. But Sen. Rand Paul (R-Ky.) blocked a motion that…
David Nosacka joins Atlantic Health as executive vice president and CFO
David Nosacka, MHA, was recently appointed executive vice president and CFO for Atlantic Health, a nonprofit health system based in Morristown, New Jersey, with eight hospitals, more than 550 care sites, 26 urgent care centers and the Atlantic Medical Group. Nosacka had previously served as senior vice president and CFO for Virginia Mason Franciscan Health,…
CMS guidance details how states can apply the Medicaid medical frailty exemption
New guidance from CMS explains how states can operationalize the medical frailty exemption to the Medicaid work requirement. Per the guidance, the intent is for states to identify medically frail beneficiaries proactively through claims and other existing data to the degree possible, thereby alleviating the administrative burden and risk of coverage loss facing those beneficiaries.…
CMS cites ACA marketplace enrollment fraud in issuing 760,000 coverage cancellations
CMS has canceled roughly 315,000 enrollments encompassing 760,000 people in Affordable Care Act (ACA) marketplace plans, citing suspected fraud, according to a Sept. 22 announcement by the Trump administration. And the numbers soon could grow. The administration also plans to commence verification of legal residency, Social Security numbers, and income and other eligibility criteria for…