Interoperability Standards and Prior Authorization for Drugs Proposed Rule Summary
HFMA provides a detailed summary of the proposed rule intended to improve the electronic exchange of health care data and streamline processes related to prior authorization by increasing the interoperability of systems used across the health care industry.
Site-neutral payment debate intensifies in hospital affordability hearing
Site-neutral payment is at the forefront of the debate on policy levers to enhance affordability in the hospital industry, as indicated during a congressional hearing Tuesday. The House Ways and Means Committee hosted a panel of hospital CEOs, seeking insights on ways to tamp down spending on hospital care. Prices in the sector have risen…
ACA marketplace constraints reduce hospital revenue, shift payer mix
Coverage changes in government healthcare programs are starting to show up in hospital financials, based on Q1 reporting from the for-profit hospital sector. Most notably, 2026 cutbacks in Affordable Care Act (ACA) marketplace coverage are manifesting in lower revenues, while hospitals are getting a taste of what’s to come next year in Medicaid coverage. In…
FY 2027 IPPS/LTCH PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2027 Medicare inpatient prospective payment system and long-term care hospital prospective payment system proposed rule published in the Federal Register on April 14, 2026.
CMS proposes electronic prior authorization for drugs
May 11 update Developments since publication of this article include CMS’s announcement that implementation of electronic prior authorization would be added to the pledges taken by participants in the Health Tech Ecosystem. The ecosystem is a public-private partnership launched in 2025 to establish a nationwide digital healthcare infrastructure that improves data interoperability and empowers patients…
2027 Medicare Advantage – Part D Final Rule Summary
HFMA provides a detailed summary of a final rule that will revise regulations affecting Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE).
Highlights of the Administration’s FY 2027 Budget
HFMA provides highlights of healthcare-related discretionary funding levels included in the President’s Discretionary Budget Request for FY 2027.
Out-of-network pricing lawsuits test MultiPlan, Zelis business models
April 27 update Zelis provided a statement to HFMA regarding the lawsuit against the company’s out-of-network pricing model (see the original story below). “Last month’s decision was procedural and does not change Zelis’s position,” a company spokesperson said. “Zelis operates with a strong commitment to integrity, transparency and full compliance with all applicable laws and…
FY 2027 Skilled Nursing Facility PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating for FY 2027 the Medicare skilled nursing facility (SNF) payment rates, SNF Quality Reporting Program and the SNF Value-Based Purchasing Program.
FY 2027 Hospice Payment Rate Update Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating the Medicare hospice payment rates, wage index and Hospital Quality Reporting Program for FY 2027.