Which healthcare policies were kept in a doomed second version of the continuing resolution?
A slimmed-down version of a year-end government funding package retained some of the core healthcare provisions from a larger previous version, but little was certain after the second version failed to pass the House of Representatives. After President-elect Donald Trump spoke out against a bipartisan agreement Wednesday night, Republicans in the House drafted a streamlined…
Year-end spending legislation looks promising for healthcare stakeholders — if it passes
Advocates for hospitals and other healthcare providers generally commended an end-of-the-year federal spending package that includes most of their requested provisions. However, a specific item loomed as a source of concern in the hospital sector, and by early Wednesday evening, there were questions about the viability of the entire bill. Congress released text for a…
CY 2025 OPPS/ASC Final Rule Summary
HFMA presents a detailed summary of the calendar year 2025 final rule for the Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system.
Understanding the signals amid the noise: What’s really happening with Medicare Advantage?
In healthcare circles, the buzz continues: Providers are exiting Medicare Advantage (MA) arrangements in large numbers. An HFMA survey found that 19% of provider organizations stopped accepting one or more MA plans in 2023 with almost 60% of respondents either planning or considering a pause on one or more MA plans in the next 24…
CY 2025 End-Stage Renal Disease PPS Final Rule Summary
HFMA presents a detailed summary of the final rule updating the end-stage renal disease prospective payment system for CY 2025.
2 proposed rules seek to stem insurers’ use of prior authorization, medical management
In its waning days, the Biden administration hopes to lay additional groundwork for curbing health plan policies regarding prior authorization in Medicare Advantage (MA), along with group health plan tactics that may interfere with access to certain preventive items and services. MA prior authorization criteria A proposed rule implementing 2026 policy and technical changes for…
A nearly $3 billion settlement with Blue Cross Blue Shield leaves providers with a big choice (updated)
Note: The second section of this article was updated Dec. 5 with news that the proposed settlement has been formally approved. Providers that contract with Blue Cross Blue Shield should assess whether they want to participate in a landmark class-action settlement over litigation stemming from complaints about the insurer’s business practices. In October, a resolution…
New CMS bundled payment initiative may be the future of Medicare
CMS's Transforming Episode Accountability Model (TEAM) is a new bundled payment model that aims to move Medicare beneficiaries into value-based care arrangements by 2030, and hospitals participating in the model will be financially responsible for the cost and quality of care for five procedures.
Medicare, Medicaid are set to cover GLP-1 drugs under a Biden administration proposal
In a major development for Medicare and Medicaid, the Biden administration has issued a proposal for the program to cover a class of weight-loss drugs that have become increasingly prevalent in society. A proposed rule implementing Medicare Advantage and Medicare Part D technical and policy changes for 2026 includes a provision to reinterpret statutory language…
CY 2025 Home Health Prospective Payment System Final Rule Summary
HFMA presents a detailed summary of the final rule published by CMS updating the Home Health Prospective Payment System rates for home health agencies, disposable negative pressure wound therapy devices, and intravenous immune globulin items and services for calendar year 2025.