CY 2027 OPPS/ASC Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule published by CMS on July 7, 2026, updating OPPS payment policies that apply to outpatient services provided to Medicare beneficiaries.
Medicare skin substitute reimbursement changes have raised provider risks
A formerly high-revenue healthcare service has been diminished on several fronts in 2026. Medicare Part B spending on skin substitutes increased by 640% between 2022 and 2024, reaching nearly $3 billion per quarter, according to a government report. Steps taken by CMS and policymakers to counter that trend include an overhauled payment system and an…
OMB grant rule raises compliance questions for hospital federal funding
Hospitals that receive federal grants are among the entities that would face new requirements under a Trump administration proposed rule. The Office of Management and Budget (OMB) issued the rule, which would increase federal oversight of how grantees apply for and use funds. The intent is for the rule to take effect Oct. 1, covering…
CY 2027 Home Health Prospective Payment System Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule that would update the payment rates for home health agencies for calendar year 2027.
MedPAC sees no broad Medicare Advantage hit to hospital finances
Recent growth in Medicare Advantage (MA) enrollment is not associated with an adverse impact on the finances of hospitals and post-acute care providers, based on findings of an observational study by the Medicare Payment Advisory Commission (MedPAC). However, the shift of beneficiaries from traditional Medicare to MA is affecting providers operationally and could be skewing…
CMS’s 2027 OPPS proposed rule would cut 340B and imaging payments
Medicare payment for 340B drugs and imaging services would incur notable reductions under CMS’s 2027 proposed rule for the hospital Outpatient Prospective Payment System (OPPS) and ambulatory surgical centers (ASCs). Payment for many services would increase due to budget neutrality requirements, but the net impact of the various changes projects to be negative for most…
Medicaid work requirement lawsuit targets CMS exemption rules
July 30 update A federal judge at the U.S. District Court for Massachusetts denied a request for a preliminary injunction of CMS regulations implementing the Medicaid work requirement. The plaintiffs specifically challenged how the regulations defined medically frail as a criterion for an exemption to the work requirement, plus how a specific short-term hardship exception…
White House zooms in on hospital contracts
The Trump administration is tightening scrutiny of provisions of contracts of hospitals with payers, which could spur additional lawsuits or legislation, say attorneys. The White House Council of Economic Advisers issued a June 18 memo laying out its case against health systems’ use of several contract provisions focused on: The memo couched a nationwide ban…
ACA marketplace enrollment decline puts coverage affordability in focus
The Trump administration released updated 2026 enrollment figures for Affordable Care Act (ACA) marketplace plans, arguing that the year-over-year decrease resulted from efforts to crack down on fraud. Enrollment fell from 22.1 million at the end of 2025 to 19.2 million in February 2026.a The drop-off largely reflects reductions in improper enrollment rather than in…
Medicare Drug Price Negotiation Program Proposed Rule Summary
HFMA provides a detailed summary of the proposed rule to codify the Medicare Drug Price Negotiation Program (“Negotiation Program”) and establish certain new policies for the Negotiation Program and the Medicare Prescription Drug Benefit Program as required by the Inflation Reduction Act of 2022 (IRA, P.L. 117-169).