J&J adds 340B claims data requirements amid growing manufacturer restrictions
Johnson & Johnson joined the list of drug manufacturers requiring providers to submit claims data on in-house pharmacy drugs as a condition of receiving discounts in the 340B Drug Pricing Program. Hospitals and other 340B covered entities have 45 days to submit the data after dispensing a covered drug, according to J&J’s policy, although certain…
2027 Medicare primary care payment changes target longstanding undervaluation
Medicare payment for primary care is set to undergo noteworthy changes in 2027, with bigger updates looming. The proposed rule for Medicare’s Physician Fee Schedule (PFS) includes provisions to address what CMS recognizes as a long-running undervaluation of primary care, according to an agency leader. “We’re embarking on a two-year strategy to change that,” Jake…
MedPAC examines Medicare spending shifts and hospital payment pressures
Depletion looms in as few as seven years for Medicare’s Hospital Insurance Trust Fund even amid long-term drops in Part A spending per beneficiary, according to insights from a meeting of the Medicare Payment Advisory Commission (MedPAC). The Congressional Budget Office (CBO) has put the depletion date at 14 years out, or seven years later…
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…
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…
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…
Hospital cyberattacks underscore growing financial and operational risks
As seen in two incidents over the past month and in a newly issued warning, cyberattacks are a relentless threat to hospitals and their communities. The South Carolina-based health system AnMed and Texas-based JPS Health experienced disruptions that included implementation of downtime procedures and patient-diversion protocols. And in recent days, the American Hospital Association highlighted…