Upcoming regulations and budget talks could be consequential for Medicaid supplemental payments
Note: This article was updated May 2. The system of directed payment programs (DPPs) has helped make Medicaid more financially viable for providers, but that system is under increasing political pressure. CMS has queued up a proposed rule that is undergoing a standard review at the Office of Management and Budget (OMB) and then is…
8 best practices for elevating and integrating RA in value-based care
As healthcare organizations work toward meeting CMS’s 2030 implementation goals for value-based care (VBC), RA should be a top concern. Too often, these organizations’ leaders mistakenly believe all that’s needed for success under VBC is to invest in a strong coding department. Many healthcare executives and clinical leaders understand the importance of RA, but they…
340B changes loom as the program attracts congressional, White House scrutiny
Both Congress and the White House are proposing 340B Drug Pricing Program changes that could add administrative burdens and ultimately limit the available savings for hospitals. A new report issued by Republican members of the Senate Health, Education, Labor and Pensions (HELP) Committee calls for changes that include requiring 340B covered entities to “provide detailed…
FY 2026 IPPS/LTCH PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule describing FY 2026 policies and rates for Medicare’s IPPS and LTCH PPS.
2026 Medicare Advantage – Part D Final Rule Summary
HFMA provides a detailed summary of the final rule revising regulations affecting Medicare Advantage, Medicare Prescription Drug Benefit, Medicare cost plans, and Programs of All-Inclusive Care for the Elderly.
CMS seeks feedback on applying MAHA guidelines in the U.S. healthcare system
The Medicare FY26 proposed rule for hospital inpatient payments offers clues as to how the Trump administration will seek to integrate principles of the Make America Healthy Again (MAHA) movement in the healthcare infrastructure. The rule includes a request for information (RFI) on using mandatory hospital quality measurement to foster improvements in nutrition and physical…
A new Trump executive order sets the stage for lower 340B payments
Hospitals can anticipate a regulatory effort to lower the Medicare payments they receive for purchases of Part B drugs through the 340B Drug Pricing Program. President Donald Trump on April 15 signed a wide-ranging executive order on drug costs, and one of the provisions directs HHS to conduct a survey of hospital acquisition costs for…
Medicare’s FY26 inpatient hospital proposed rule includes a restrained payment update
The Trump administration’s first set of Medicare proposals establishing inpatient payment rates continued what hospital advocates describe as a long-term trend in which the annual update is lacking. A 3.2% increase in the market basket would be reduced by a 0.8% statutory productivity adjustment, according to the newly released FY26 proposed rule. Hospitals that meet…
How the 340B remedy payments will affect upcoming Medicare Advantage payment rates
Hospital advocates found reason for concern in a narrow aspect of the Medicare Advantage (MA) final payment rate notice for 2026. With health plans lauding the average 5.06%, $25 billion revenue increase they’re projected to reap in the upcoming year, hospitals may wonder about adverse impacts from an applied reduction in CMS’s calculation of the…
Final 2026 rule for MA, Part D leaves out proposed GLP-1 drug coverage
The Trump administration’s final rule setting policy and technical changes for Medicare Advantage (MA) in 2026 did not carry forward a proposal regarding GLP-1 drug coverage, but key provider-focused provisions were retained. The rule, which is scheduled for formal publication April 15 and also sets 2026 Medicare Part D policies, excludes a Biden administration proposal…