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…
MedPAC finds the hospital industry is on a more stable financial footing now
Hospitals do not need a Medicare payment boost for 2027 beyond the update to be provided in the statutory formula, says the Medicare Payment Advisory Commission (MedPAC). Whereas the commission had recommended that Congress increase hospital payments by an additional 1% or 1.5% ahead of each year from 2024 through 2026, the recommendation for 2027…
Questions loom over the future of telehealth policy
Federal telehealth policy continues to prove confounding for healthcare providers. The recent 43-day government shutdown marked the first extended period since the early days of the COVID-19 pandemic that traditional restrictions on telehealth reimbursement were in place. Medicare waivers of those restrictions helped telehealth utilization surge during the pandemic and remain elevated in the years…
At the 11th hour, an Affordable Care Act subsidy accord remains elusive (updated Dec. 18)
Dec. 18 update The only year-end healthcare legislation to pass at least one chamber of Congress does not include an extension of the Affordable Care Act (ACA) enhanced subsidies, but members have not given up on reaching an agreement in early 2026. House Republicans passed a bill Dec. 17 that includes provisions (see the Dec.…
Hospitals hope litigation will stop the 340B rebate model before it gets started
Hospitals are going to court in an effort to thwart major changes to the 340B Drug Pricing Program. The American Hospital Association (AHA) was among a group that filed a lawsuit against the federal government Dec. 1, seeking to have implementation of a planned 340B rebate model halted before it begins Jan. 1. Under the…
Bold Conversations for a Healthier System
With support from: Dear Colleagues, It is an unmistakable reality that the U.S. healthcare system is becoming less affordable and more financially unsustainable — and all without improvements in health outcomes to show for it. Now is the time for healthcare leadership to change the conversation and pursue real solutions. That’s why I want to…
CMS’s latest transparency rule aims to make price estimates more specific
Hospitals face additional and potentially more demanding price transparency reporting requirements in 2026, as finalized in new CMS regulations. The final rule for hospital outpatient departments and ambulatory surgical centers includes provisions building off the current transparency regulations. The new language is intended to ensure that hospitals “provide meaningful, accurate information about the amount they…
2026 Medicare final rule postpones a significant payment cut for hospitals
While implementing several policies that could constrain hospital finances next year and beyond, CMS offered temporary relief on one count. The Medicare 2026 final rule for hospital outpatient departments and ambulatory surgical centers (ASCs) was proposed to include an across-the-board 2% cut to base payments. But CMS, acknowledging the concerns of hospitals, kept the scheduled…
Senate hearing doesn’t resolve 2026 funding for Affordable Care Act marketplace plans
Senate Republicans used a recent hearing to press their case for enacting immediate reforms to part of the Affordable Care Act (ACA), with little sign they will agree to extend the subsidy framework that has been in place for more than four years. During the Nov. 19 hearing of the Senate Finance Committee, members of…
CMS gives new guidance on upcoming restrictions to Medicaid provider taxes
CMS issued preliminary guidance about how it will implement new restrictions on Medicaid provider taxes as required by the budget reconciliation law known as the One Big Beautiful Bill Act (OBBBA). OBBBA language will curb provider taxes as a Medicaid funding mechanism through which states can increase their allotment of federal matching dollars that, in…