Senate Medicaid hearing highlights the debate over federal spending cuts
Cuts to federal Medicaid spending are necessary to streamline the program and don’t necessarily portend tough times for providers, conservative policymakers and analysts argued during a Senate hearing. The Aug. 4 hearing of the Senate Budget Committee included discussion of whether healthcare policies in the One Big Beautiful Bill Act (OBBBA) should be scaled back…
SUSTAIN 340B Act proposes major changes for hospitals and pharmacies
A bipartisan working group in Congress released a preliminary legislative draft that attempts to resolve some of the most disputed aspects of the 340B Drug Pricing Program. One noteworthy provision in the legislation would curtail the 340B rebate model, which was finalized by the Health Resources and Services Administration on July 31 and is scheduled to begin Jan.…
CJR-X mandatory bundled payment model begins for hospitals in 2028
Hospitals have 17 months to prepare for the first mandatory nationwide alternative payment model, as established in Medicare’s FY27 final rule for the Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs). The final rule makes no major changes to the proposal issued earlier this year for the CJR-X Model, which will require most…
HRSA sets 2027 launch for the 340B rebate model, announces requirements
The Health Resources and Services Administration (HRSA) followed through with plans to pilot a rebate model for the 340B Drug Pricing Program beginning Jan. 1, 2027. As described in a notice published July 31, HRSA previously scrapped plans for a 2026 pilot following litigation. In response to that legal challenge, the agency provided additional information…
Hospital financial performance strained by payer mix and rising costs
Hospital financial performance remained uneven in the second quarter as policy changes and broader economic pressures affected the not-for-profit (NFP) and for-profit segments. In the NFP sector, median health system operating margin ticked upward to 0.4% year-to-date (YTD) through May, according to monthly data from Strata Decision Technology. But the metric wasn’t quite as steady…
New data on No Surprises Act IDR cases show providers won often in 2025
Providers and their intermediaries continued to flourish in the No Surprises Act’s independent dispute resolution (IDR) process during the second half of 2025, according to newly released data from the federal departments overseeing IDR. Among 1.15 million disputes that received payment determinations during the six-month period, providers won 85%. That share generally tracked trends seen…
Healthcare price transparency legislation gains momentum in Congress
Price transparency bills continue to be a focus in Congress as an area to pursue in possible year-end healthcare legislation. Two House committees and a Senate committee approved bills within the past two weeks. Among various other healthcare bills that have made it out of the committees are: There was significant bipartisan support at the…
Medicaid provider tax proposed rule could cut payments by $220 billion over 10 years
A proposed rule from CMS implements anticipated changes to the system of provider taxes that help fund supplemental reimbursement in Medicaid. The changes are required under the One Big Beautiful Bill Act (OBBBA, also referred to as the Working Families Tax Cut legislation), with the proposed rule filling in details. The repercussions of the rule…
MultiPlan antitrust litigation gains momentum after rulings for providers
Healthcare providers obtained two favorable rulings over the last month in their massive antitrust litigation against a vendor’s repricing algorithm. The case entails allegations that MultiPlan — which since has rebranded as Claritev — conspired to set out-of-network (OON) payment rates by gathering competitively sensitive information from roughly 700 health plans and using that information…
Judge blocks key ACA marketplace rule provisions for 2027
For the second consecutive year, a federal judge has provided relief to plaintiffs challenging Trump administration regulations that are intended to tighten limits on Affordable Care Act (ACA) marketplace coverage. A July 16 ruling by Judge Brendan Hurson with the U.S. District Court for Maryland halted implementation of key provisions in recently finalized regulations that…