FY 2025 IPPS/LTCH PPS Final Rule Summary
HFMA presents a detailed summary of the final rule published by CMS in the August 1, 2024, Federal Register describing FY 2025 policies and rates for Medicare’s hospital IPPS and LTCH PPS.
Congressional hearing highlights the favored approach to cutting Medicaid funding
A recent hearing of the House Oversight and Government Reform Committee showcased the rationale Republicans will use in pursuing significant Medicaid spending cuts. The Feb. 25 hearing was called to examine various federal programs that made the Government Accountability Office’s (GAO’s) High-Risk List for 2025. Because of the ongoing stakes for Medicaid, much of the…
Settlement participation in Blues litigation may pose concerns for hospitals, attorney says
As the deadline fast approaches for hospitals to decide whether to participate in a record-setting class-action settlement with Blue Cross Blue Shield, competing views of the situation remain. By March 4, hospitals have to alert the settlement administrator if they want to opt out of the $2.8 billion agreement, which also includes injunctive relief said…
Medicaid proponents weigh in as potentially big cuts come under consideration on Capitol Hill
Feb. 26 update: In a vote on the evening of Feb. 25, the House passed the budget resolution. Specifics of the spending cuts will now be drafted by the respective House committees, and the House and Senate will then have to agree on the final bill. Supporters of healthcare providers and consumers are growing increasingly…
Deadline nears for deciding whether to partake in $2.8 billion Blue Cross Blue Shield settlement
In less than two weeks, healthcare providers face a deadline to decide whether to stay in a record-setting settlement stemming from a class-action lawsuit against Blue Cross Blue Shield (BCBS). The $2.8 billion settlement, a portion of which is available to any provider that furnished items or services to a Blues plan member between July…
Trump administration starts to tweak the Affordable Care Act as subsidy debate looms
Coming off a period of record enrollment, the Affordable Care Act (ACA) insurance marketplaces face the prospect of constriction in upcoming years. The Trump administration quickly moved to limit federal funding for a program that helps people select an ACA health plan. On Feb. 14, the administration announced that funding for the ACA Navigator program…
RFK Jr. officially becomes HHS secretary as pressing healthcare policy questions mount
Robert F. Kennedy Jr. was sworn in Feb. 13 as the new secretary of HHS, and current events in healthcare policy make clear that he’ll be busy in the role. With the Senate having confirmed him by a partisan vote of 52-48, Kennedy faces urgent matters aside from generating momentum for his signature policy of…
Various 340B issues mean potential headaches for providers in 2025
The 340B Drug Pricing Program, a key source of cost savings for participating hospitals, faces intensifying pressure in the early part of the new year. Drug companies are pursuing efforts to limit the ability of hospitals to realize their full allotment of savings, while Congress eyes the program as a possible way to trim federal…
Latest on the Affordable Care Act marketplaces: Will recent enrollment surge be short-lived?
In its final days, the Biden administration tried to cement gains made during the past few years in the uptake of insurance coverage provided through the Affordable Care Act (ACA) marketplaces. A final rule published Jan. 15 seeks to carry the recent momentum into 2026 via small steps and technical updates such as changes to…
Direct-to-employer benefit design: A providers’ starter guide
Following a decade of experience in developing value-based care bundle programs, Nashville, Tenn.-based Vanderbilt University Medical Center (VUMC) has enjoyed success in direct contracting with employers that demonstrates the ripe market opportunity such contracting offers. Health systems that want to seize this opportunity can benefit from applying VUMC’s lessons learned during this process to their…