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).
Medicare funding projections sharpen concerns over access and payment rates
The latest annual report on the state of Medicare funding reflects a conundrum for healthcare industry stakeholders. Medicare spending on healthcare services is on an increasingly difficult fiscal track, projected to rise from $1.2 trillion in 2025 to $2 trillion in 2035. Yet as acknowledged in the report issued this month by the Medicare trustees,…
FY27 HHS budget proposal includes rural health gains, CDC cuts
HHS discretionary funding in FY27 would decrease by close to 4% from current appropriations, according to a budget proposal that advanced out of the House Appropriations Committee this month. The $110.8 billion allocation would be roughly $4 billion lower than FY26 enacted funding. The budget appears to preserve more funding for traditional programs, relative to…
DOJ’s OhioHealth antitrust settlement affects payer contracts
The U.S. Department of Justice and OhioHealth have settled antitrust litigation that hinged on allegations concerning the health system’s contracting practices. A June 16 filing with the Southern District of Ohio federal court states that the parties, which also include the state of Ohio, reached a consent decree in which OhioHealth does not admit wrongdoing…
No Surprises Act arbitration may raise premiums and healthcare costs, CBO says
The Congressional Budget Office (CBO) may need to rethink its original projection that the No Surprises Act would save money for the federal government, the agency said this week in a recommendation for additional research on the issue. In 2021, the CBO estimated that the newly signed law would lower provider payments, especially out-of-network rates,…
HFMA Comments on the FY 2027 Hospital IPPS and LTCH Proposed Rule
HFMA comments on CMS’s FY 2027 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Proposed Rule.