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 in greater amounts 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) ushers…
Transparency in Coverage proposed rule aims to make price files more usable
HHS’s proposed updates to health plan price transparency files mark a notable step in ensuring the information is useful for providers and other healthcare stakeholders, experts say. The Transparency in Coverage (TiC) proposed rule issued in December would modify requirements for health plans with an eye toward making the massive machine-readable files (MRFs) more navigable…
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…
Updated documentation requirements in Medicare could add burden on healthcare providers
Citing concerns about improper payments, CMS issued a regulatory update that expands Medicare prior authorization and other documentation requirements starting April 13. The regulations are most meaningful for vendors of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), but the operations of hospitals and other front-line providers stand to be affected as well. Increased documentation…
340B watch: HHS cancels immediate plans for a rebate model (updated)
Feb. 13 update HHS’s Health Resources and Services Administration issued a request for information (RFI) on whether it “should implement a rebate model under the 340B Program and how best to operationalize any such rebate framework for stakeholders.” The RFI asks what the impact of a rebate model would be on 340B providers, manufacturers, pharmacies…
Value-based payment gains policy consensus after 15 years of CMMI models
Saying it’s time to phase out the fee-for-service payment model would have been controversial a decade ago, but today such sentiment is accepted in policy circles, according to insights from a recent webinar. In a discussion among past directors of the 15-year-old Center for Medicare & Medicaid Innovation (CMMI), a key takeaway was the degree…
CMS establishes tighter limits on the structure of Medicaid tax arrangements
Nearly seven months after passage of the legislation known as the One Big Beautiful Bill Act (OBBBA), finalized regulations from CMS apply additional constraints to the use of healthcare taxes as a Medicaid funding source. A rule set for formal publication Feb. 2 is intended to create Medicaid savings in part by reducing the matching…
Expiration of ACA enhanced subsidies would pose high financial risk for hospitals in 12 states
Amid a continuing push in Congress to extend the Affordable Care Act (ACA) enhanced subsidies, a new analysis identifies the states where expiration would have the biggest financial impact on hospitals. Not-for-profit hospitals in a dozen states are at high risk of negative credit shocks if the subsidies are not renewed, according to a Fitch…
Projected Medicare Advantage 2027 payment rate draws concern from plans and providers
CMS’s proposed Medicare Advantage (MA) 2027 payment rate would result in minimal overall growth for health plans, with average payments to MA plans projected to increase by only 0.09%, according to the MA advance rate notice published this week. MA policy increasingly has grabbed headlines in conjunction with the program’s enrollment surge from 33% of…
Health insurers tell Congress their operations aren’t the cause of high healthcare costs
The debate over the root causes of surging healthcare costs came to Capitol Hill this week as health insurance executives defended their business models to Congress. While acknowledging bipartisan criticism after a year when the cost of employer-sponsored family coverage grew by 6%, with similar or larger projections for 2026, the executives said the crux…