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…
2027 Medicare Physician Fee Schedule proposed rule includes broad payment changes
Physicians will incur a payment decrease in 2027 unless Congress intervenes, according to a CMS proposed rule issued July 14 for the Medicare Physician Fee Schedule. Statutory provisions call for increases of 0.75% for clinicians participating in advanced alternative payment models (APMs) and 0.25% for nonparticipants. However, those raises and a 0.53% bump stemming from…
Medicare skin substitute reimbursement changes have raised provider risks
A formerly high-revenue healthcare service has been diminished on several fronts in 2026. Medicare Part B spending on skin substitutes increased by 640% between 2022 and 2024, reaching nearly $3 billion per quarter, according to a government report. Steps taken by CMS and policymakers to counter that trend include an overhauled payment system and an…
OMB grant rule raises compliance questions for hospital federal funding
Hospitals that receive federal grants are among the entities that would face new requirements under a Trump administration proposed rule. The Office of Management and Budget (OMB) issued the rule, which would increase federal oversight of how grantees apply for and use funds. The intent is for the rule to take effect Oct. 1, covering…
MedPAC sees no broad Medicare Advantage hit to hospital finances
Recent growth in Medicare Advantage (MA) enrollment is not associated with an adverse impact on the finances of hospitals and post-acute care providers, based on findings of an observational study by the Medicare Payment Advisory Commission (MedPAC). However, the shift of beneficiaries from traditional Medicare to MA is affecting providers operationally and could be skewing…
CMS’s 2027 OPPS proposed rule would cut 340B and imaging payments
Medicare payment for 340B drugs and imaging services would incur notable reductions under CMS’s 2027 proposed rule for the hospital Outpatient Prospective Payment System (OPPS) and ambulatory surgical centers (ASCs). Payment for many services would increase due to budget neutrality requirements, but the net impact of the various changes projects to be negative for most…
House bill would increase tax-exempt hospital reporting requirements
A bill that advanced out of a House committee Wednesday would add significant reporting requirements for tax-exempt hospitals. As passed by the Ways and Means Committee, the Tax-Exempt Hospital Transparency Act includes increased reporting obligations in areas such as community benefit, charity care, the 340B Drug Pricing Program and service-line spending. Requirements would be more…
Medicaid work requirement lawsuit targets CMS exemption rules
A coalition of more than 20 states filed suit to vacate key parts of recent regulations implementing the Medicaid work requirement, arguing that CMS overstepped its bounds. Litigation filed in the U.S. District Court for Massachusetts states that key parts of a recently issued interim final rule with comment period (IFR) deviate from congressional intent…
ACA marketplace enrollment decline puts coverage affordability in focus
The Trump administration released updated 2026 enrollment figures for Affordable Care Act (ACA) marketplace plans, arguing that the year-over-year decrease resulted from efforts to crack down on fraud. Enrollment fell from 22.1 million at the end of 2025 to 19.2 million in February 2026.a The drop-off largely reflects reductions in improper enrollment rather than in…
340B bill would levy various restrictions on participating hospitals
Legislative language overhauling the 340B Drug Pricing Program faces a long and uncertain path in Congress but would have significant implications if some of the provisions become law. A preliminary bill draft released by Sen. Bill Cassidy (R-La.) would tighten oversight of hospitals and contract pharmacies, increase transparency and require 340B discounts to be transferred…