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…
David Johnson: HHS launches a host of transformative payment models (Oh my!)
In the annals of healthcare policy, historians will celebrate December 2025 as the month when HHS revolutionized federal payment for care delivery and drugs. In quick succession, the agency introduced 10 new, transformative and entirely practical models designed by and largely run through the Center for Medicare and Medicaid Innovation (CMMI). Beyond creative acronyms, these programs share several attributes: They…
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…
Why Drug Reimbursement Varies So Widely & What Providers Can Do About It
Download this trends report, which analyzes millions of hospital- and payer-reported drug rates to uncover how reimbursement actually works across today’s most expensive therapeutic areas.
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…
How a looming federal mandate will affect hospitals
Nick and Shawn discuss appropriations efforts and how various provisions will affect hospitals, specifically in outpatient department claims. Note: After the recording of this episode, the parties hit a roadblock on the bill that was the main topic of discussion. Check out our news coverage for the latest.
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…
Site-neutral payment emerges as Medicaid savings tool in GOP reconciliation plan
Congressional Republicans are touting healthcare competition and consumer choice, along with expanded site-neutral payment, in a preliminary framework for a second reconciliation bill. The Republican Study Committee in the U.S. House of Representatives put forth ideas geared toward healthcare policies, home prices, energy prices, credits for stay-at-home parents and more, along with proposals to cut…
Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model Summary
HFMA presents a detailed summary of CMMI’s Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model.
Trump releases healthcare plan that would have major implications for the industry
President Donald Trump’s newly released healthcare plan would promote transparency and consumerism and usher in significant changes to coverage, with some stakeholders saying more information is necessary to make a valid assessment of the pros and cons. Touted as a push to address wider issues with affordability, the plan requires Congress to fill in the…