CMS proposes 2027 ACA marketplace changes to address rising premiums
With few signs of pending relief for increased premiums in the Affordable Care Act (ACA) insurance marketplaces, CMS issued proposals designed to solidify the affordability and availability of coverage next year. In recent weeks, the Senate has made little or no announced progress on agreeing to an extension of the enhanced subsidies for buying ACA…
Comparison of 2026 ASC Addendum BB with October 2025 Addendum BB
This spreadsheet compares ASC covered ancillary services integral to covered surgical procedures. The spreadsheet also includes an HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a HCPCS code.
Comparison of 2026 ASC Addendums AA and FF with October 2025 Addendums
HFMA presents a spreadsheet for relative weights and payment rates for ASC covered surgical procedures at the HCPCS level, comparing 2026 to 2025 rates.
340B watch: HHS cancels immediate plans for a rebate model (updated)
March 9 update Hospitals prevailed in litigation over a 340B mandate that has imposed additional administrative requirements in the program. A federal court ruled that the Health Resources and Services Administration (HRSA) lacked statutory authority to establish that off-campus hospital outpatient departments (HOPDs) are eligible for 340B prices only if they first appear on their…
MACPAC January 2026 Public Meeting Summary
HFMA presents a detailed summary of the Medicaid and CHIP Payment and Access Commission’s (MACPAC’s) public meeting held on January 29-30, 2026.
Value-based payment gains policy consensus after 15 years of CMMI models
Saying it’s time to phase out the fee-for-service payment model would have been controversial a decade ago, but today such sentiment is accepted in policy circles, according to insights from a recent webinar. In a discussion among past directors of the 15-year-old Center for Medicare & Medicaid Innovation (CMMI), a key takeaway was the degree…
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.