CMS undertakes Medicare Worksheet S-12 audits of hospital cost reports
CMS is emphasizing hospital compliance with updated Medicare cost-reporting requirements, recently announcing an audit of first-year submissions of a brand-new worksheet. For cost-reporting periods ending on or after Jan. 1, 2026, most hospitals paid under the Inpatient Prospective Payment System have had to complete Worksheet S-12. Those submissions will be subject to auditing by a…
CMS proposes Medicare Advantage provider directory requirements for 2028
Medicare Advantage (MA) plans are set to face requirements aimed at improving the accuracy of provider directories, according to a proposed rule. Issued Oct. 16 by CMS, the proposed regulations would implement provisions of the Consolidated Appropriations Act of 2026 (CAA 2026). Beginning in 2028, new mandates applicable to network-based MA plans and certain private…
How proposed restrictions on corporate practice of medicine could affect hospitals
Hospitals would face new restrictions on some of their business practices, according to language in recently proposed legislation. However, the core provision of the Stop Corporate Takeovers of Physicians Act of 2026 would exempt hospitals. A ban on ownership or majority control of a medical practice would apply to insurance companies, private equity funds and…
CMS exclusion authority brings new fraud enforcement questions for providers
HHS’s decision to grant CMS exclusion authority creates a new enforcement consideration for healthcare providers participating in federal programs. HHS Secretary Robert F. Kennedy Jr. announced the update during a July news conference, and an Oct. 14 regulatory notice formalized the change, effective immediately. The notice gives CMS permissive exclusion authority under the Social Security…
Hospital financial performance improves as Medicaid funding risks grow
Going back to early 2026, hospital and health system financials have started to reflect industry responses to H.R. 1, the One Big Beautiful Bill Act (OBBBA). In new reporting (registration required) from Strata Decision Technology on first-half 2026 trends, health system financial performance improved over the six-month period, even as margins remained tight. After falling…
340B rebate model lawsuit seeks to halt 2027 rollout, citing hospital costs
Oct. 12 Update Another potential challenge to the 340B rebate model is forming in Congress, where a bipartisan quartet in the House introduced the 340B Rebate Model Delay Act on Oct. 9. The legislation, which has not yet been posted, would delay the model until 2029 to give Congress more time to evaluate the financial…
2027 Medicare Advantage Star Ratings show gains in high-rated plan enrollment
More than 70% of beneficiaries in Medicare Advantage (MA) plans that include prescription drug coverage are in contracts rated at least four stars out of five, according to CMS’s Star Rating release for 2027. Those plans are in line for quality-bonus payments and in 2028 will receive higher rebates that are used to support supplemental…
Hospital obstetric service closures grow as Congress considers responses
Amid deteriorating access to maternity care across the U.S., Congress is trying to find solutions, while recent data indicate how the situation is playing out at hospitals. A September 2026 report by the University of Minnesota’s Rural Health Research Center states that hospital-based obstetric services declined nationwide between 2010 and 2024, with 718 instances of…
FTC expands healthcare price transparency enforcement as HHS updates rules
Notable government actions on healthcare price transparency have taken place this week, with the Federal Trade Commission (FTC) opening a new front in enforcement of hospital price transparency and HHS updating regulations for health plans. Although hospital price transparency enforcement has primarily fallen under the purview of CMS, the FTC says breaches of transparency requirements…
340B rebate model takes shape for 2027 with 10 manufacturers, 21 drugs
The new rebate model for the 340B Drug Pricing Program took a step closer to implementation Oct. 1 with the announcement of the initial cohort of participating manufacturers and covered drugs. The Health Resources and Services Administration (HRSA) posted 10 manufacturers and 21 drugs that have been approved for the pilot, which is scheduled to…