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…
340B rebate model no longer beginning Jan. 1 after court issues preliminary injunction (updated Jan. 8)
Note: The last section of this article was updated with the latest news on 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 Court for Maine requires the Health…
Voices in Healthcare Finance: Looking ahead to 2026
Nick Hut and Shawn Stack discuss what’s coming in healthcare in 2026 with Katie Gilfillan from HFMA’s policy team.
What to expect from an inpatient-outpatient site-neutral payment system for Medicare
A recent final rule for the Medicare outpatient prospective payment system (OPPS) gradually eliminates over a three-year period the requirement that some procedures can only be performed in an inpatient site of service.a In the rule, CMS eliminates what is colloquially known as the “inpatient-only list” to make more procedures eligible to be performed in…
Alternative Payment Model Updates and the Increasing Organ Transplant Access Model Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule that would update and revise the Increasing Organ Transplant Access (IOTA) Model.
MACPAC December 2025 Public Meeting Summary
HFMA presents a detailed summary of the Medicaid and CHIP Payment and Access Commission’s (MACPAC’s) public meeting held on December 11, 2025.
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…
OBBBA Medicaid impacts: How to navigate state-directed payment revenue reduction
On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law, initiating one of the most significant shifts in federal fiscal policy in recent years. The legislation introduces sweeping tax reforms and spending reductions, with healthcare providers positioned to experience the most substantial impact. OBBBA authorizes a $1 trillion reduction in federal Medicaid spending…
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…