ACA marketplace coverage changes reduce hospital revenue, shift payer mix
Changes to reimbursement in government healthcare programs are starting to show up in hospital financials, based on Q1 reporting from the for-profit hospital sector. Most notably, 2026 cutbacks in Affordable Care Act (ACA) marketplace coverage are manifesting in lower revenues, while hospitals are getting a taste of what’s to come next year in Medicaid coverage.…
FY 2027 IPPS/LTCH PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2027 Medicare inpatient prospective payment system and long-term care hospital prospective payment system proposed rule published in the Federal Register on April 14, 2026.
CMS proposes electronic prior authorization for drugs
Amid ongoing implementation of federally required electronic prior authorization for healthcare items and services, CMS now proposes to do the same for pharmaceuticals. New regulations would apply to drugs under both medical and pharmacy benefits, according to a proposed rule published April 14. Faxes and payer portals for drug authorizations would be phased out in…
2027 Medicare Advantage – Part D Final Rule Summary
HFMA provides a detailed summary of a final rule that will revise regulations affecting Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE).
Highlights of the Administration’s FY 2027 Budget
HFMA provides highlights of healthcare-related discretionary funding levels included in the President’s Discretionary Budget Request for FY 2027.
Out-of-network pricing lawsuits test MultiPlan, Zelis business models
April 27 update Zelis provided a statement to HFMA regarding the lawsuit against the company’s out-of-network pricing model (see the original story below). “Last month’s decision was procedural and does not change Zelis’s position,” a company spokesperson said. “Zelis operates with a strong commitment to integrity, transparency and full compliance with all applicable laws and…
FY 2027 Skilled Nursing Facility PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating for FY 2027 the Medicare skilled nursing facility (SNF) payment rates, SNF Quality Reporting Program and the SNF Value-Based Purchasing Program.
FY 2027 Hospice Payment Rate Update Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating the Medicare hospice payment rates, wage index and Hospital Quality Reporting Program for FY 2027.
Medicare payment policy changes for 2027: Key signals from Kennedy hearings
Amid ample rancor, some of the rhetoric during congressional appearances Thursday by HHS Secretary Robert F. Kennedy Jr. had substantive implications for healthcare industry stakeholders. During two House hearings to discuss his department’s proposed FY27 budget, Kennedy and members of the Ways and Means Committee and a subpanel of the Appropriations Committee touched on a…
FY 2027 Inpatient Psychiatric Facilities PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2027 Inpatient Psychiatric Facilities Prospective Payment System proposed rule, published in the April 7, 2026, Federal Register.