Hospital-insurer contract disputes could intensify as cost pressures persist
Relationships between hospitals and health insurers are expected to undergo further strain this year, according to analysts with a leading credit ratings agency. “Providers are still dealing with rising operating costs, labor supplies and infrastructure that outpace what insurers have been willing to pay in recent years,” said Bradley Ellis, senior director for the U.S.…
Affordable Care Act subsidy extension progresses, but many questions persist (updated Jan. 13)
Note: A section of this article has been updated with the latest ACA enrollment numbers for 2026 Momentum in Congress is building toward an extension of the enhanced subsidies for buying Affordable Care Act (ACA) marketplace coverage, although successful passage would not negate the ongoing uncertainty. On Jan. 8, the House of Representatives passed a…
CMMI payment models signal broader Medicare reimbursement shifts
CMS’s Center for Medicare & Medicaid Innovation (CMMI) was busy during the last two months of 2025, announcing a number of new models designed to improve healthcare and keep costs in check. Some address specific priorities of President Donald Trump or HHS Secretary Robert F. Kennedy Jr. New models scheduled for implementation over the next…
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…
340B rebate model no longer beginning Jan. 1 after court issues preliminary injunction (updated Jan. 12)
Note: The last section of this article was updated with news that HHS is stepping back from its appeal of the litigation. A federal court stopped implementation of a 340B Drug Pricing Program rebate model that had drawn fierce opposition from providers. The Dec. 29 preliminary injunction by a Trump-appointed judge at the U.S. District…
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…
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…