CMS finalizes the program integrity rule for the Affordable Care Act insurance marketplaces
CMS formally implemented an Affordable Care Act marketplace rule that is expected to reduce plan enrollment in the name of program integrity, but the agency took steps to try to mitigate the long-term impact. Unlike in the earlier proposed rule, the final rule allows some of the new restrictions on enrollment to sunset after 2026.…
Part A hospital spending is helping to accelerate Medicare insolvency, trustees say
The costs of hospital inpatient care are a key driver in forecasts that the Medicare Hospital Insurance (HI) Trust Fund will run out of money within eight years. As described in the latest annual report of the Medicare trustees, the projection of a 2033 insolvency date represents a three-year acceleration from last year’s estimate. Changes…
HFMA Comments on Unleashing Prosperity Through Deregulation of the Medicare Program (Executive Order 14192) RFI
HFMA submits recommendations pertaining to the Unleashing Prosperity Through Deregulation of the Medicare Program (Executive Order 14192) - Request for Information.
Health systems say the budget reconciliation bill is bad news for patients and hospitals
Even before a Senate committee produced legislative text that would increase the Medicaid cuts in the budget reconciliation bill, hospitals were preparing to amplify their opposition to the bill. The changes wrought by the Senate are likely to make the matter more urgent for hospitals that could be exposed to potentially significant revenue declines. After…
Senate version of the budget reconciliation bill does not look promising for providers
Note: The lead section of this article was updated June 17 with clarifying information on state-directed payments. As released late Monday afternoon, the Senate Finance Committee’s healthcare proposals that would be part of the budget reconciliation bill go beyond the House bill in constraining Medicaid spending. Key changes from the version passed by the House…
Indiana law with big implications for hospital pricing may be a bellwether
A landmark hospital pricing bill that recently became law in Indiana could foreshadow similar developments in other states. Indiana hospitals will face both a tax penalty and the loss of their tax-exempt status if their prices exceed designated limits. The limits, to be determined via a formula set by the state’s Office of Management and…
Why Medicare Advantage provisions could end up in the budget reconciliation bill
This article was updated June 12. According to early discussions in the Senate, a final version of the budget reconciliation bill could reduce the amount of federal spending in Medicare Advantage (MA). The Senate is considering whether to modify the reconciliation bill passed by the House, and one topic of conversation is how to achieve…
More details on HHS budget proposals for FY26
An updated version of President Donald Trump’s FY26 budget request to Congress includes new information on how proposed spending cuts would affect HHS and its subsidiary agencies. As described in a summary, the request calls for “radical change” to improve the performance of the U.S. healthcare system, reiterating previously reported ideas for shrinking and restructuring…
CMS announces process change for short-stay inpatient claim reviews in Medicare
Recent CMS directives for hospitals include a process change regarding Medicare patient status reviews. Beginning Sept. 1, Medicare administrative contractors (MACs) will conduct the reviews used to determine the appropriateness of Part A payment for adjudicated short-stay inpatient hospital claims. The reviews to date have been conducted by Beneficiary and Family Centered Care Quality Improvement…
House passes budget reconciliation bill that would dramatically affect healthcare coverage
June 10 update: The article was updated with news from the White House about Medicaid state-directed payments. June 4 update: The article was updated with the Congressional Budget Office’s formal score of the legislation passed by the House. A sweeping federal policy bill that includes major changes to Medicaid is halfway toward becoming law after…