New federal rule means big changes in coverage of behavioral healthcare
Landmark regulations issued by the Biden administration are intended to establish coverage parity for behavioral healthcare services. A newly published final rule prohibits group health plans, along with health insurers offering group or individual insurance coverage, from restricting access to mental-health and substance-use disorder (SUD) benefits as compared with medical and surgical benefits. The rule,…
Medicare administrative contractor news includes a data breach and potential consolidation
Recent happenings involving Medicare administrative contractors (MACs) include a notice of a data breach and a request for feedback on possible consolidation. CMS sent out word that nearly 950,000 Medicare beneficiaries whose claims go through Wisconsin Physicians Service Insurance Corporation (WPS) are being informed that their protected health information or other personally identifiable information may…
HHS concedes defeat in litigation over providers’ use of tracking technologies on websites
The hospital lobby cemented its victory in litigation about online tracking tools after HHS canceled its planned appeal. In June, the American Hospital Association (AHA) and co-plaintiffs won a decision in a Texas federal court about 2022 guidance (revised and somewhat softened in 2024) instructing hospitals and other HIPAA-covered entities to avoid using online tracking…
Congress only has a few more months to ensure expansive telehealth access continues
The clock is ticking on efforts to maintain the telehealth flexibilities that have been in place since the start of the COVID-19 pandemic, with advocates hoping Congress will act before year’s end. Key waivers will conclude at the close of 2024 unless legislation is passed to extend them. Congress faced a similar scenario in 2022…
ONC issues proposed technical standards to improve health information sharing
Proposed regulations bring healthcare providers and patients a step closer to gaining access to key health information stored in payer databases. Provisions in a proposed rule published Aug. 5 by the Office of the National Coordinator for Health Information Technology (ONC) support a CMS final rule released in 2020 and another issued early this year,…
Johnson & Johnson looks to make a big change in how hospitals obtain 340B price discounts
A leading drug manufacturer opened a new chapter in the fight with hospitals over the 340B Drug Pricing Program, requiring the use of a rebate program to receive discounts. Following manufacturer efforts over the last several years to limit the discounts available to providers through contract pharmacies, Johnson & Johnson announced it would offer 340B…
A key election question: What will happen to the enhanced Affordable Care Act subsidies?
Earl Pomeroy knows from experience that the politics surrounding the Affordable Care Act (ACA) are dicey. As a Democratic member of the House Ways and Means Committee, Pomeroy helped pass the ACA during his ninth term representing North Dakota. After that, “I lost my job,” he recalled. Since his time in Congress ended with his…
HFMA’s editorial team earns its 20th award this year
The American Society of Journalists & Authors (ASJA) awarded Jeni Williams, a regular contributor to hfm, with an honorable mention for the special report, “SDOH: Leader or convener? Hospitals and health systems still struggle with their role,” which she wrote in 2023 as part of HFMA’s Healthcare 2030 series. Williams’ recognition in the ASJA’s B2B…
The financial state of the not-for-profit hospital sector: key takeaways from the latest medians
The financial condition of the U.S. not-for-profit (NFP) hospital industry can be described as steadily improving but still struggling, according to insights from two of the three main credit-rating agencies. Fitch Ratings and S&P Global both recently issued reports on sector medians, using audited data from 2023. The companies described an industry that has rebounded…
Hospitals see a margin advantage as care migrates to the outpatient department
The site-of-care shift toward the outpatient setting increasingly is manifesting in margin per case, according to recent financial data. “While overall margins for both inpatient and outpatient hip and knee replacement surgeries have declined, outpatient procedures now have higher margins than inpatient procedures,” Strata Decision Technology wrote in its Performance Trends Report for Q2 (registration…