Budget reconciliation bill faces a rocky road as Medicaid and ACA cuts draw provider concerns
In the days after a key House committee approved legislation that includes substantial cuts to Medicaid funding, the bill’s path forward remained full of obstacles. The healthcare portion of the budget reconciliation bill passed the Energy and Commerce Committee on a party-line 30-24 vote May 14. Since then, reports from Capitol Hill have detailed the…
RFK Jr. defends HHS budget to Congress and talks Medicaid, 340B and more
In congressional testimony, HHS Secretary Robert F. Kennedy Jr. endorsed proposed Medicaid cuts as affecting fraud, waste and abuse rather than beneficiaries who most need the program. Speaking May 14 before a House Appropriations subcommittee and later the Senate Health, Education, Labor and Pensions (HELP) Committee, Kennedy also indicated a willingness to pare down the…
Medicaid provider payments take a hit in budget reconciliation bill
As released over the weekend, formalized plans to reduce federal Medicaid spending would have an impact on future state-directed supplemental payments and other aspects of the program. The House Energy and Commerce (E&C) Committee published its portion of a budget reconciliation bill that would slash 10-year projected federal spending. As expected, Medicaid would incur the…
Providers, payers both struggle with Medicare Advantage challenges
Note: This article was updated May 13 where noted. Neither providers nor a leading payer are finding much reason for satisfaction with the state of Medicare Advantage (MA) these days. Q1 financial reporting by for-profit hospital chains and by UnitedHealth Group (UHG), among other payers, have reflected the challenging landscape. UHG in April shared what…
Trump proposes big spending cuts to healthcare programs
President Donald Trump’s FY26 budget proposal includes significant cuts to healthcare programs, but the administration says the reductions will not affect core services. The budget is merely a set of recommendations, given that federal budgetary authority resides with Congress. Trump’s proposals are likely to hold influence with the narrow Republican majorities in both chambers, but…
Blue Cross Blue Shield settlement concerns linger as date of final approval nears
Nearly 15,500 healthcare providers are known to have withdrawn from the record-setting Blue Cross Blue Shield antitrust settlement, retaining the option to pursue separate litigation. The number was listed in an April court filing as the parties move toward a July 29 hearing at which the presiding court is scheduled to consider final approval of…
Supreme Court: HHS can maintain DSH formula approach that results in lower payments
The Supreme Court dealt hospitals a loss in a case about Medicare disproportionate share hospital (DSH) payments, saying HHS can continue using a disputed interpretation of the payment formula. Published April 29, a 7-2 decision for the federal government in Advocate Christ Medical Center, et al. v. Kennedy allows for continuation of a policy whereby…
FY 2026 Inpatient Psychiatric Facilities PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2026 Inpatient Psychiatric Facilities PPS proposed rule, released by CMS on April 11, 2025.
Upcoming regulations and budget talks could be consequential for Medicaid supplemental payments
Note: This article was updated May 2. The system of directed payment programs (DPPs) has helped make Medicaid more financially viable for providers, but that system is under increasing political pressure. CMS has queued up a proposed rule that is undergoing a standard review at the Office of Management and Budget (OMB) and then is…
8 best practices for elevating and integrating RA in value-based care
As healthcare organizations work toward meeting CMS’s 2030 implementation goals for value-based care (VBC), RA should be a top concern. Too often, these organizations’ leaders mistakenly believe all that’s needed for success under VBC is to invest in a strong coding department. Many healthcare executives and clinical leaders understand the importance of RA, but they…