CMS’s Medicaid state-directed payment rule would expand limits beyond hospitals
CMS’s proposed rule on Medicaid state-directed payments (SDPs) would implement limits authorized by the One Big Beautiful Bill Act (OBBBA) while applying restrictions to a broader swath of Medicaid, including certain fee-for-service (FFS) supplemental payments. Essentially, the agency issued proposed regulations that would take some of the OBBBA’s Medicaid provisions a step further. Services previously…
Healthcare compliance risks rise as CMS expands fraud enforcement
With recent developments highlighting the Trump administration’s emphasis on healthcare fraud prevention, providers should ensure their compliance processes are working optimally. The administration has taken various steps in 2026, including this month. On May 13, CMS announced it was withholding $1.3 billion in Medicaid funding from California. During media availability at the White House that…
ACA marketplace final rule could add to payer-mix concerns for providers
In new regulations setting coverage parameters for Affordable Care Act (ACA) marketplace health plans, CMS is attempting to intertwine increased program integrity with greater flexibility for states and insurers. The balancing act is part of an effort to fortify the marketplaces in a year when enrollment already has fallen by more than 1 million after…
Healthcare price transparency is heading for a more consequential phase
Key developments loom for healthcare price transparency both legislatively and in the private sector, according to insights from a recent congressional hearing. Sen. Bill Cassidy (R-La.), who is a physician and an influential healthcare policymaker in Congress, conducted a field hearing May 5 with stakeholders in his home state to examine the issue of healthcare…
The Hospital of the Future Part I: Can healthcare leaders deliver a healthier future?
With support from: It’s a scene “The Jetsons” might have portrayed: A patient scheduled for surgery checks into the hospital by scanning a QR code with her smartphone, then is digitally led to her room. There, a smart TV welcomes her and orients her to the room. Soon, a robot arrives, delivering the gown she’ll change into…
GLP-1 coverage costs pressure employers and Medicare plans in 2026
Even as evidence accumulates about the efficacy of GLP-1 drugs, concerns surrounding insurance coverage of the products remain unresolved. Both employers and insurers are trying to navigate the dichotomy between clinical benefits and potentially burdensome costs. “Against the backdrop of anticipated double-digit healthcare cost increases, fueled to a large degree by GLP-1s and overall prescription…
Hospital workplace violence escalates financial and workforce pressures
Incidents of violence in U.S. workplaces are disproportionately common in healthcare settings, especially in hospital emergency departments (EDs), and new data helps quantify the toll. It’s long been known that healthcare and social service workers are significantly more likely than workers overall to suffer a workplace violence injury. Bureau of Labor Statistics data suggest the…
States and hospitals prepare for new administrative tasks as Medicaid work requirements loom
Efforts by states to implement the Medicaid work requirement are intensifying, with hospitals likely to play a supporting administrative role when the requirement begins nationwide Jan. 1, 2027, based on findings in a new report. As legislated in the One Big Beautiful Bill Act (OBBBA), adults in the Medicaid expansion population must demonstrate that they…
PAMA laboratory data reporting requirements for hospitals are set to impact Medicare lab payments
Hospitals offering clinical diagnostic laboratory services should take note of imminent reporting obligations that will affect Medicare payment rates. Reporting of commercial final-paid claim rates as the basis for Medicare rate setting was included in the Protecting Access to Medicare Act of 2014 (PAMA) and initially took place in 2017. Subsequent phases of data reporting…
Site-neutral payment debate intensifies in hospital affordability hearing
Site-neutral payment is at the forefront of the debate on policy levers to enhance affordability in the hospital industry, as indicated during a congressional hearing Tuesday. The House Ways and Means Committee hosted a panel of hospital CEOs, seeking insights on ways to tamp down spending on hospital care. Prices in the sector have risen…