Court decisions on ACA marketplace rules affect key coverage provisions
As CMS moves ahead with Medicaid funding limits for gender-affirming care in minors, Democratic state leaders used litigation to block restrictions in the Affordable Care Act (ACA) insurance marketplaces. The ACA policy, established in 2025 regulations, would remove the essential health benefit (EHB) designation from gender-affirming care. EHB status allows ACA consumer protections, such as…
FY 2027 IPPS/LTCH PPS Final Rule Summary
HFMA presents a detailed summary of the FY 2027 Medicare inpatient prospective payment system and long-term care hospital prospective payment system final rule published in the Federal Register on August 4, 2026.
No Surprises Act QPA calculations set to change after appeals court ruling
An appeals court sided with providers in a case about the No Surprises Act’s qualifying payment amount (QPA), a key benchmark in out-of-network payment determinations. The U.S. Court of Appeals for the Fifth Circuit issued a ruling that QPA calculations must not include ghost rates, referring to non-negotiated rates listed in contracts for services a…
Improving the healthcare system for women
Nick Hut talks about 2027 Proposed Rules for the Physician Fee Schedule with Katie Gilfillan. Erika Grotto interviews Terry Hush of Roji Health Intelligence about how the healthcare industry can better serve women.
Guilty plea in UnitedHealthcare CEO killing comes amid sustained focus on obstacles to care
Luigi Mangione pleaded guilty Aug. 14 to federal stalking charges in the 2024 fatal shooting of UnitedHealthcare’s CEO, potentially bringing resolution to an incident that spurred introspection by insurers and the healthcare industry. The charges, stemming from the killing of Brian Thompson on Dec. 4, 2024, carry a maximum penalty of life in prison. Prosecutors…
HHS report raises scrutiny of gender-affirming care billing and coding
HHS followed up its final rule blocking Medicaid funding for gender-affirming care in minors by publishing a commissioned report alleging “potentially fraudulent” billing and coding among providers of the services. The report, released Aug. 13, alleges that financial incentives drove hospitals and physicians to expand access to the care, and that deceitful billing practices took…
CMS ends Medicaid coverage of gender-affirming care for minors
Federal Medicaid funding no longer will be available to cover gender-affirming healthcare for minors, according to a CMS final rule issued Aug. 11. The rule blocks Medicaid and Children’s Health Insurance Program (CHIP) federal matching funds from reimbursing providers for what the rule refers to as “sex-rejecting procedures” in beneficiaries younger than 18 in Medicaid…
CMS proposes new 340B reporting and HOPD attestation requirements
Recently published editions of two annual Medicare proposed rules both included provisions creating new administrative tasks for hospitals. CMS’s proposed rule for hospital outpatient care would formalize a system of required attestation for off-campus hospital sites starting in 2028, while the rule for physician payments would establish obligatory submission of 340B-related data to a centralized…
CY 2027 Physician Fee Schedule Proposed Specialty Impact Tables
HFMA presents a spreadsheet containing a detailed specialty impact analyses based on the 2027 Medicare Physician Fee Schedule proposed rule.
FY 2027 Inpatient Psychiatric Facilities PPS Final Rule Summary
HFMA presents a detailed summary of the final rule updating prospective payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services provided by inpatient psychiatric facilities.