Study details how OBBBA Medicaid cuts will restructure state budgets
A handful of states may gain financially because of the Medicaid provisions legislated in the 2025 reconciliation bill known as the One Big Beautiful Bill Act (OBBBA), according to a new study. Results of an analysis by RAND Health include the finding that state Medicaid budgets will fall by $664 billion between 2025 and 2034,…
GAO examines No Surprises Act payment and network trends
Recent trends seen as a consequence of the No Surprises Act (NSA) include a moderate increase in the share of providers going in-network for some services, according to a report by the Government Accountability Office (GAO). Such a development was a secondary goal of the 2020 year-end legislation and could belie concerns that the large…
Medicare GME funding reform debate focuses on rural hospitals
Better-targeted funding is essential to ensure the clinical talent pipeline meets the needs of hospitals in rural and underserved areas, according to insights at a recent congressional hearing. Phelps Health, a rural Missouri hospital, has benefited from federal and state planning and development grants that enabled the launch of a family medicine residency with enhanced…
Hospitals mount response as site-neutral payment policy progresses
Hospitals and their advocates think the concept of site-neutral payment is gaining enough traction in policy circles that a strategic response is warranted. One step in attempting to stanch the apparent momentum of site-neutral policies is the release of a new report that finds recommended approaches would cut hospital payments by $182 billion over 10…
CMS provides more leeway to Medicaid state-directed payments before new limits kick in
CMS issued guidance that expands the opportunity for providers to receive a key Medicaid supplemental payment at a higher rate over the next two years. The bulletin regarding Medicaid state-directed payments (SDPs) makes it easier for states to maintain eligibility for higher SDPs before the legislation known as the One Big Beautiful Bill Act (OBBBA)…
Medicaid Program; Closing a Health Care-Related Tax Loophole Final Rule Summary
HFMA presents a detailed summary of a final rule published by CMS to address what it describes as a loophole in a regulatory statistical test applied to state proposals for Medicaid tax waivers.
Diving into the FY26 appropriations bill and CMS’s new ACCESS Model
Katie Gilfillan discusses a noteworthy new payment model from CMS, and Nick and Shawn review of key healthcare aspects of the FY26 budget bill.
CMS proposes 2027 ACA marketplace changes to address rising premiums
With few signs of pending relief for increased premiums in the Affordable Care Act (ACA) insurance marketplaces, CMS issued proposals designed to solidify the affordability and availability of coverage next year. In recent weeks, the Senate has made little or no announced progress on agreeing to an extension of the enhanced subsidies for buying ACA…
Comparison of 2026 ASC Addendum BB with October 2025 Addendum BB
This spreadsheet compares ASC covered ancillary services integral to covered surgical procedures. The spreadsheet also includes an HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a HCPCS code.
Comparison of 2026 ASC Addendums AA and FF with October 2025 Addendums
HFMA presents a spreadsheet for relative weights and payment rates for ASC covered surgical procedures at the HCPCS level, comparing 2026 to 2025 rates.