FTC expands healthcare price transparency enforcement as HHS updates rules
Notable government actions on healthcare price transparency have taken place this week, with the Federal Trade Commission (FTC) opening a new front in enforcement of hospital price transparency and HHS updating regulations for health plans. Although hospital price transparency enforcement has primarily fallen under the purview of CMS, the FTC says breaches of transparency requirements…
340B rebate model takes shape for 2027 with 10 manufacturers, 21 drugs
The new rebate model for the 340B Drug Pricing Program took a step closer to implementation Oct. 1 with the announcement of the initial cohort of participating manufacturers and covered drugs. The Health Resources and Services Administration (HRSA) posted 10 manufacturers and 21 drugs that have been approved for the pilot, which is scheduled to…
Elevance Health brings commercial site-neutral payment to hospital claims
Elevance Health is moving site-neutral payment concepts into commercial reimbursement, with a Sept. 29 announcement setting the stage for constraints on hospital payment. The insurer said it would incorporate a series of new billing policies “intended to address increasingly common situations where care provided at an off-campus location is billed at a higher hospital rate.”…
Healthcare price transparency legislation hits a roadblock in the Senate
Despite widespread, bipartisan support, legislation expanding price transparency remains in limbo in the Senate as Congress considers healthcare policies for inclusion in a year-end package. The Senate seemed on track to pass the Patients Deserve Price Tags Act (S. 2355) on an accelerated basis Sept. 24. But Sen. Rand Paul (R-Ky.) blocked a motion that…
David Nosacka joins Atlantic Health as executive vice president and CFO
David Nosacka, MHA, was recently appointed executive vice president and CFO for Atlantic Health, a nonprofit health system based in Morristown, New Jersey, with eight hospitals, more than 550 care sites, 26 urgent care centers and the Atlantic Medical Group. Nosacka had previously served as senior vice president and CFO for Virginia Mason Franciscan Health,…
CMS guidance details how states can apply the Medicaid medical frailty exemption
New guidance from CMS explains how states can operationalize the medical frailty exemption to the Medicaid work requirement. Per the guidance, the intent is for states to identify medically frail beneficiaries proactively through claims and other existing data to the degree possible, thereby alleviating the administrative burden and risk of coverage loss facing those beneficiaries.…
CMS cites ACA marketplace enrollment fraud in issuing 760,000 coverage cancellations
CMS has canceled roughly 315,000 enrollments encompassing 760,000 people in Affordable Care Act (ACA) marketplace plans, citing suspected fraud, according to a Sept. 22 announcement by the Trump administration. And the numbers soon could grow. The administration also plans to commence verification of legal residency, Social Security numbers, and income and other eligibility criteria for…
2027 Medicare lab fee schedule points to 15% cuts across many test codes
Preliminary data for the 2027 Clinical Laboratory Fee Schedule (CLFS) indicate substantial downward pressure on Medicare reimbursement for lab services. CMS released information on the 2027 payment rates ahead of final rates expected in November, projecting that the methodology used to set the rates would save $1 billion annually for Medicare. Hospital-based and freestanding labs…
CMS’s ACCESS Model expansion adds chronic care tracks for Medicare providers
CMS continues to put weight behind the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a 10-year initiative to apply value-based payment and digital solutions to chronic disease management. The agency announced Sept. 15 that it would add to the services covered under the model. Newly covered conditions effective April 1, 2027, are set…
Debate on hospital merger antitrust review draws focus to access and margins
Amid recurring criticism about the impact of hospital-led consolidation, a new report recommends that regulators look beyond price increases in evaluating mergers within the sector. Commissioned by the American Hospital Association and prepared by Kaufman Hall, the report states that merger reviews should also consider hospital financial stability, access to care and the impact on…