CMS gives updates on upcoming Medicaid state-directed payment limits
CMS has issued guidance to Medicaid programs about implementing required restrictions on the state-directed payments (SDPs) made through Medicaid managed care organizations (MCOs). The budget reconciliation law known as the One Big Beautiful Bill Act (OBBBA) includes a provision that all SDPs submitted after July 4 for hospitals must be limited to the Medicare rate…
Senate, House release diverging HHS budget proposals for FY26 (updated-2)
Note: This article was updated Sept. 16 with news about a short-term continuing funding resolution and Sept. 10 with new numbers for some provisions in the House appropriations bill. Sept. 16 update Republicans in the House are focusing on a short-term continuation of FY25 federal funding as the most direct route to avoiding a partial…
Report by HFMA and Eliciting Insights examines hospitals’ journey to realize the potential of AI
Although healthcare AI technology has been in the pipeline for years, new feedback suggests implementation remains a work in progress at hospitals and health systems. As described in an HFMA report produced with Eliciting Insights, most organizations are still striving to develop an AI strategy and install an AI governance structure. Findings of the report…
Court limits CMS’s authority to immediately apply the ACA marketplace program integrity final rule
A federal judge blocked many of the Trump administration’s plans to constrict enrollment in Affordable Care Act (ACA) marketplace health plans in the name of program integrity. In an Aug. 22 ruling, Judge Brendan Hurson (a Biden appointee) of the U.S. District Court for Maryland issued a stay of key provisions of a CMS final…
Healthcare fraud enforcement ramps up in the Trump administration, with implications for all stakeholders
Even as hospital leaders consider how to manage decreased reimbursement and higher costs, federal fraud enforcement continues to have some of the most significant financial stakes of any healthcare industry issue. Rather than taking a hands-off approach, the Trump administration is maintaining and even expanding the Biden administration’s push in this area. Two months ago,…
CBO breaks down how and when the budget reconciliation bill will reduce insurance enrollment
The Congressional Budget Office (CBO) released its most detailed projections yet about how the budget reconciliation bill stands to affect healthcare coverage. According to data published Aug. 11 as part of a report requested by Democratic congressional leaders, the CBO estimates that 10 million people will be uninsured in 2034 because of the new law.…
Latest on the Blue Cross Blue Shield settlement: Numbers revealed on filed claims, opt-outs (updated)
Oct. 8 update The lead attorneys for the class of plaintiffs in the Blue Cross Blue Shield provider litigation are highlighting portions of the judge’s final approval of the $2.8 billion settlement, saying his comments should provide reassurance about the ability to bring future litigation against the Blues. Per the settlement terms, participants cannot sue…
Ahead of expected turmoil, the hospital sector is on solid footing
With uncertainty on the horizon for healthcare operations, hospitals and health systems appear to have established a stable foundation from which to respond to challenges. Recently reported financial data offers further indication that the not-for-profit (NFP) hospital sector has attained a measure of equilibrium several years after the pandemic and the ensuing turbulence in labor…
Key Senate committee eyes healthcare reform in the name of affordability
As described at a recent Senate hearing, hospitals, insurers and pharmacy benefit managers (PBMs) all are under scrutiny by Congress in efforts to curb the growth in healthcare costs. The Senate Health, Labor Education and Pensions (HELP) Committee held a July 31 hearing to examine ways to make healthcare more affordable for consumers and other…
Aetna’s new payment policy could leave hospitals at a disadvantage
Hospitals should take note of an insurer’s new approach regarding the two-midnight rule, especially given the potential implications if the policy becomes widely adopted. In a recent communication, Aetna said providers that contract with the company’s Medicare Advantage (MA) plans and Medicare Special Needs Plans face a new policy beginning Nov. 15 in instances when…