CMS distributes $10 billion for states to use to improve rural health
CMS awarded states $10 billion in rural health funding for 2026, implementing a widely anticipated provision of the legislation known as the One Big Beautiful Bill Act (OBBBA). The Rural Health Transformation Program (RHTP) funding is intended to help rural healthcare providers succeed amid the projected cutbacks in federal Medicaid funding over the next decade…
The WISeR prior authorization model for Medicare is set to pose challenges for hospitals
Hospitals and other healthcare providers soon will have a larger set of prior authorization requirements to account for in traditional Medicare as a new pilot model gets underway. Technology companies participating in the six-year, six-state Wasteful and Inappropriate Service Reduction (WISeR) Model are supposed to have their portals up and running by Jan. 5, with…
Elevance Health rebuffs providers’ calls to cancel a contentious out-of-network payment policy
Healthcare providers in 11 states face the imminent possibility of payment reductions from a top subsidiary of Elevance Health, one of the nation’s largest insurers. Anthem Blue Cross and Blue Shield announced this quarter that it would apply a 10% penalty to the allowed amount on commercial insurance claims when hospital care is provided by…
CMS plans to bar hospitals from Medicare and Medicaid participation for providing gender-affirming care to minors
Note: The final section of this article has an update on related litigation filed against HHS. Hospitals would face significant financial consequences for providing gender-affirming care as treatment for minors who have gender dysphoria, according to a newly proposed rule from CMS. Specifically, any hospital offering care such as puberty blockers, hormone therapy and surgery…
OBBBA Medicaid impacts: How to navigate state-directed payment revenue reduction
On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law, initiating one of the most significant shifts in federal fiscal policy in recent years. The legislation introduces sweeping tax reforms and spending reductions, with healthcare providers positioned to experience the most substantial impact. OBBBA authorizes a $1 trillion reduction in federal Medicaid spending…
Texas hospitals fall short in an appellate ruling about disproportionate share hospital payment calculations
An appeals court dealt hospitals a defeat in a case about Medicare disproportionate share hospital (DSH) payments, reversing a lower court’s prior ruling on jurisdictional grounds last week. A Dec. 9 decision by a three-judge panel at the U.S. Court of Appeals for the Fifth Circuit means certain Section 1115 waiver days can remain excluded…
MedPAC finds the hospital industry is on a more stable financial footing now
Hospitals do not need a Medicare payment boost for 2027 beyond the update to be provided in the statutory formula, says the Medicare Payment Advisory Commission (MedPAC). Whereas the commission had recommended that Congress increase hospital payments by an additional 1% or 1.5% ahead of each year from 2024 through 2026, the recommendation for 2027…
Aligning for a Sustainable Healthcare Future
Segments of the U.S. healthcare system often operate at cross purposes, meaning improved alignment will be vital to achieving systemic progress. Fragmentation is apparent not only between payers and providers or clinicians and administrators, but also in the tension between efforts to innovate while keeping care cost-effective, and between formulating policy and putting it into…
Questions loom over the future of telehealth policy
Federal telehealth policy continues to prove confounding for healthcare providers. The recent 43-day government shutdown marked the first extended period since the early days of the COVID-19 pandemic that traditional restrictions on telehealth reimbursement were in place. Medicare waivers of those restrictions helped telehealth utilization surge during the pandemic and remain elevated in the years…
Reimagining the patient financial experience
Patients judge their healthcare experience long before they see a clinician. In an era of consumer-driven healthcare, transparency, affordability and ease of use are now as critical as clinical outcomes. Yet, while the care experience has evolved, the financial journey still lags behind. Hospitals that elevate the patient financial experience — making it as seamless,…