This week The Centers for Medicare & Medicaid Services announced that it is lifting a suspension on hospital survey activities that was implemented during this winter's surge in COVID-19 cases and hospitalizations. An immediate resumption of...
Last Thursday, the Medicare Payment Advisory Commission (MedPAC) submitted its annual March Report to Congress. The Congressional advisory panel has long been critical of the Medicare Advantage (MA) program, but in this report it finds that the federal government will pay 14% more than if the 35 million beneficiaries enrolled in the...
New policies from the Centers for Medicare and Medicaid Services are disrupting rural health clinics' participation in value-based payment models. But a new study shows that while federal programs have increased patient access and quality of care, they have thus far failed to curb rising costs.
When the Trump administration entered...
Early this week, the Centers for Medicare and Medicaid Services (CMS) posted a proposed rule that would overhaul Affordable Care Act (ACA) exchange plan regulations, including ending standardized coverage and broadening access to catastrophic plans.
The rule would repeal a 2023 requirement that federal exchanges and state-based...
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposal for the 2027 Medicare Advantage (MA) and Part D Advance Notice. The agency proposed a slight increase of 0.09%, shocking shares of publicly traded insurance companies.
The meager increase proposal comes after the Trump administration granted a generous...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services (CMS) issued a new proposed rule that would overhaul disclosure rules for health payers' pricing and cost-sharing determinations.
The 2020 Transparency in Coverage (TiC) rule required payers to disclose cost-sharing information in a machine-readable format and create...
The Centers for Medicare and Medicaid Services announced a new drug pricing model to allow state Medicaid agencies and Medicare Part D plans to cover GLP-1 drugs at lower costs. The announcement comes as Novo Nordisk seeks to regain lost ground in the race for dominance in the American GLP-1 market and its pill version of Wegovy is...
The Centers for Medicare & Medicaid Services established a new Office of Rural Health Transformation on December 22, consolidating responsibility for the $50 billion Rural Health Transformation Program within the agency, according to a notice published in the Federal Register. The office will serve as CMS’s central point of control...CMS Rules
On December 8, the Centers for Medicare and Medicaid Services (CMS) posted preliminary guidance for the Medicaid work requirements mandated by the One Big Beautiful Bill Act (OBBBA), which passed into law on July 4 this year.
The law requires the creation of new rules by June 2026 and CMS notes in the guidance overview that further...CMS Rules
On Friday, the Centers for Medicare and Medicaid Services (CMS) issued its final rule for the 2026 Home Health Prospective Payment System.
The payment rule will decrease aggregate Medicare payments to home health agencies by 1.3% or $220 million, which is far less than it had proposed in June. According to Home Health Care News, the...
Mandatory staffing minimums at nursing homes were officially repealed in an interim final rule published last week.
The rule had already been struck down by a federal court in April and was placed under a moratorium until 2034 by President Donald Trump's landmark spending reform bill earlier this year. Modern Healthcare reports that...
Last week, the Centers for Medicare and Medicaid Services made hospitals very unhappy with the 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS) final rule, which includes major plans for site-neutral payments and price transparency policies.
The rule gives both outpatient departments and...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services (CMS) announced the 2026 Medicare Parts A and B Premiums and Deductibles and the 2026 Medicare Part D Income-Related Monthly Adjustment Amounts. This included an announcement that traditional Medicare premiums would rise 10% year-over-year.
The Medicare Part B premium, which...CMS Rules
Late last week, the Centers for Medicare and Medicaid Services (CMS) issued new guidance on how it intends to implement restrictions on Medicaid provider taxes, as required by the One Big Beautiful Bill Act (OBBBA), signed into law by President Donald Trump earlier this year. The guidance outlines a transition timeline for states to...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary drug pricing model for Medicaid programs called GENErating Cost Reductions fOr U.S. Medicaid (GENEROUS). The awkward acronym is directly from CMS.
The GENEROUS model aims to allow state Medicaid programs to purchase drugs at lower costs, and will...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the 2026 Medicare Physician Fee Schedule. The rule includes a 2.5% pay boost for physicians but creates a 2.5% reduction for 7,700 billing codes for services. It also makes changes to telehealth reimbursement and the Medicare Shared Savings...CMS Rules
A federal court has sided with the plaintiffs in Humana Inc. v. Xavier Becerra, which challenged the Centers for Medicare and Medicaid Services (CMS) 2023 final rule for risk adjustment data validation (RADV) audits.
Judge Reed O'Connor for the Northern District of Texas granted Humana's motion for summary judgement challenging the...CMS Rules
President Donald Trump has struck a deal with Pfizer in his first step towards establishing TrumpRx, a discount drug website operated by the federal government. The agreement arrives in tandem with the announcement of a new drug pricing pilot from the Centers for Medicare and Medicaid Services (CMS) that indicates a resurrection of the...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) issued a final rule requiring Medicare Advantage insurers submit their provider directories to the agency for incorporation into the Medicare Plan Finder Portal.
CMS announced a plan last month to assemble provider lists and add them to the plan finder ahead of the...
In lieu of extending the Affordable Care Act (ACA) enhanced premium tax credits, the Trump administration is boosting access to catastrophic plans.
Catastrophic plans cover preventative care but carry very high deductibles. Historically, they've only been available for people under 30 who don't otherwise qualify for subsidies, but the...CMS Rules
The Centers for Medicare and Medicaid Services issued final rules for the hospice payment rate, the Medicare inpatient psychiatric facility prospective payment system (IPF PPS), and related quality reporting programs for fiscal year (FY) 2026.
CMS will update the IPF PPS payment rate by 2.5%, based on the 2021 market basket increase...
