No Surprises Act arbitration may raise premiums and healthcare costs, CBO says
The Congressional Budget Office (CBO) may need to rethink its original projection that the No Surprises Act would save money for the federal government, the agency said this week in a recommendation for additional research on the issue. In 2021, the CBO estimated that the newly signed law would lower provider payments, especially out-of-network rates,…
340B rebate model pilot advances as providers warn of added costs
The Health Resources and Services Administration (HRSA) continues to take steps toward implementing a rebate model for the 340B Drug Pricing Program. After soliciting comments on a planned model over a two-month period, HRSA sent an updated notice May 27 to the Office of Management and Budget (OMB) for a review that remains ongoing. That…
Kennedy and Oz alert hospitals that penalties loom for price transparency noncompliance
The emphasis on enforcing and advancing healthcare price transparency ramped up this week in the Trump administration and on Capitol Hill. HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, MD, made an announcement on social media, saying more than 500 hospitals have not complied with changes to price transparency requirements that took…
OBBBA Medicaid cuts increase credit risk for NFP hospitals
Looming healthcare cuts as legislated in the One Big Beautiful Bill Act (OBBBA) constitute the biggest risk to the not-for-profit (NFP) hospital industry, according to insights from experts with the leading credit-rating agencies. The OBBBA is set to hit Medicaid over the next few years, bringing potentially sizable reductions to enrollment along with direct cuts…
340B claims data requirements put hospital discounts under stress
June 18 update Eli Lilly has followed through with cutting off 340B discounts for certain hospitals that have yet to submit the required claims data (see the original story below), provider advocacy groups said Thursday. “As a result of Lilly’s decision to deny hospitals access to 340B pricing for the company’s products unless they submit…
Medicaid work requirement rule adds significant wrinkles to program eligibility criteria
For state agencies and potentially healthcare providers, CMS’s regulatory guidance on implementing the Medicaid work requirement imposes responsibilities that go beyond language seen in the underlying statute. CMS published an interim final rule with comment period late Monday, just barely meeting the June 1 deadline established in the 2025 reconciliation law known as the One…
Healthcare affordability and financial sustainability concerns test CFO strategy
Healthcare stakeholders can implement strategies that improve both affordability for consumers and financial sustainability for providers, according to insights from a recent panel discussion. The effort should start with “making sure that we understand what this balance is of financial sustainability of the institution and affordability for the patients, for the consumers, for the communities…
Final rule lowers No Surprises Act IDR fees, adds requirements
Regulations issued Thursday to update the No Surprises Act’s independent dispute resolution (IDR) process represent an effort to improve access while also streamlining the volume of cases. CMS and the Departments of Labor and Treasury published a final rule that significantly lowers IDR fees but includes more requirements of the insurers and providers that seek to use…
340B lawsuits against CVS allege $250M in underpaid hospital reimbursement
CVS Health’s pharmacy benefit manager (PBM) under-reimbursed three health systems by almost $250 million over five years in connection with the 340B Drug Pricing Program, according to new lawsuits. Filed in three separate federal courts, the complaints describe how CVS Health and its subsidiaries retained a large share of the savings generated through the 340B…
Off-campus outpatient billing rules could extend to commercial claims
Hospitals preparing for new off-campus outpatient department (OPD) billing requirements in Medicare may soon face a parallel mandate for commercial claims. The House Education and Workforce Committee on May 21 unanimously passed the Transparency in Billing Act, which would prohibit commercial health plans from paying claims that do not include a unique identifier for the…