Value-based payment gains policy consensus after 15 years of CMMI models
Saying it’s time to phase out the fee-for-service payment model would have been controversial a decade ago, but today such sentiment is accepted in policy circles, according to insights from a recent webinar. In a discussion among past directors of the 15-year-old Center for Medicare & Medicaid Innovation (CMMI), a key takeaway was the degree…
CMS establishes tighter limits on the structure of Medicaid tax arrangements
Nearly seven months after passage of the legislation known as the One Big Beautiful Bill Act (OBBBA), finalized regulations from CMS apply additional constraints to the use of healthcare taxes as a Medicaid funding source. A rule set for formal publication Feb. 2 is intended to create Medicaid savings in part by reducing the matching…
Expiration of ACA enhanced subsidies would pose high financial risk for hospitals in 12 states
Amid a continuing push in Congress to extend the Affordable Care Act (ACA) enhanced subsidies, a new analysis identifies the states where expiration would have the biggest financial impact on hospitals. Not-for-profit hospitals in a dozen states are at high risk of negative credit shocks if the subsidies are not renewed, according to a Fitch…
Projected Medicare Advantage 2027 payment rate draws concern from plans and providers
CMS’s proposed Medicare Advantage (MA) 2027 payment rate would result in minimal overall growth for health plans, with average payments to MA plans projected to increase by only 0.09%, according to the MA advance rate notice published this week. MA policy increasingly has grabbed headlines in conjunction with the program’s enrollment surge from 33% of…
Health insurers tell Congress their operations aren’t the cause of high healthcare costs
The debate over the root causes of surging healthcare costs came to Capitol Hill this week as health insurance executives defended their business models to Congress. While acknowledging bipartisan criticism after a year when the cost of employer-sponsored family coverage grew by 6%, with similar or larger projections for 2026, the executives said the crux…
Site-neutral payment emerges as Medicaid savings tool in GOP reconciliation plan
Congressional Republicans are touting healthcare competition and consumer choice, along with expanded site-neutral payment, in a preliminary framework for a second reconciliation bill. The Republican Study Committee in the U.S. House of Representatives put forth ideas geared toward healthcare policies, home prices, energy prices, credits for stay-at-home parents and more, along with proposals to cut…
New administrative mandate for hospitals signed into law as part of FY26 appropriations
Note: The headline and lead section of this article were updated with news that Congress passed the appropriations bill. The FY26 appropriations bill signed Feb. 3 by President Donald Trump leaves hospitals with two years to prepare for a new administrative obligation pertaining to off-campus outpatient departments (OPDs). The package, which passed the Senate last…
Hospital use and service intensity helped fuel healthcare spending growth in 2024
Increasing use and intensity of hospital care, physician and clinical services, and retail prescription drugs led a continued surge in U.S. healthcare spending in 2024, according to newly released data. National health expenditures (NHE) reached $5.3 trillion, a 7.2% increase year-over-year and comparable with the 7.4% jump recorded in 2023. Except for the pandemic year…
Trump releases healthcare plan that would have major implications for the industry
President Donald Trump’s newly released healthcare plan would promote transparency and consumerism and usher in significant changes to coverage, with some stakeholders saying more information is necessary to make a valid assessment of the pros and cons. Touted as a push to address wider issues with affordability, the plan requires Congress to fill in the…
No Surprises Act IDR enforcement uncertain after Supreme Court declines review
Inaction by the Supreme Court this week raised new questions about enforcement of the No Surprises Act’s independent dispute resolution (IDR) process. The high court denied a petition by two air ambulance companies to review a circuit court’s 2025 decision that IDR awards are not enforceable in federal court. That opinion by the U.S. Court…