Final 2026 rule for MA, Part D leaves out proposed GLP-1 drug coverage
The Trump administration’s final rule setting policy and technical changes for Medicare Advantage (MA) in 2026 did not carry forward a proposal regarding GLP-1 drug coverage, but key provider-focused provisions were retained. The rule, which is scheduled for formal publication April 15 and also sets 2026 Medicare Part D policies, excludes a Biden administration proposal…
Questions about Medicaid cuts are unresolved in latest budget reconciliation blueprint (updated)
Note: This article was updated April 10 with the latest news on steps forward in the reconciliation process and a rollback of a specific set of funding by CMS. As released this week, the Senate’s latest budget reconciliation blueprint provides few answers about the impact a final bill could have on federal healthcare spending, in…
New processes for Medicare patient-status appeals have arrived, with implications for finance teams (updated)
If they have not done so already, hospitals should establish processes for responding to new regulations concerning status-appeal rights for Medicare beneficiaries. The regulations have taken effect in early 2025 after being published in an October 2024 final rule. That rule stemmed from the outcome of litigation that had begun 15 years earlier. Per the…
HFMA’s Nelson receives AONL Honorary Member Award
Updated April 4, 2025 Todd Nelson, chief partnership executive and director of healthcare finance policy for HFMA, was selected to receive the American Organization for Nursing Leadership’s Honorary Member Award. The award recognizes Nelson for his support of AONL’s mission and his contribution to advancing healthcare through AONL’s core business. AONL, an affiliate of the…
With finances more stable, healthcare CFOs eye growth opportunities
Even with lingering financial constraints, healthcare CFOs see room for initiatives that will help their organizations enhance revenue and perhaps even profitability. “We’re finally in that post-pandemic phase in the sense that organizations are starting to see margins stabilize,” said Alina Henderson, vice president for healthcare solutions with Strata Decision Technology. In Strata’s survey (registration…
HHS restructures for the DOGE era
A massive HHS restructuring announced March 27 could have an indirect impact on providers. Secretary Robert F. Kennedy Jr. announced HHS would reduce its workforce by 10,000 FTEs, part of a 25% downsizing from 82,000 to 62,000, with previously announced early retirements and buyouts also factoring into the count. The department’s agencies will be pared…
Hospitals’ Medicaid appeal options may be more limited after court ruling
A recent appeals-court ruling restricts options for hospitals seeking to use litigation to ensure prompt Medicaid payment. The March 14 ruling by the U.S. Court of Appeals for the Seventh Circuit in Saint Anthony Hospital v. Whitehorn essentially states that hospitals do not have a legal right to sue state Medicaid programs under federal law…
Hospital financial metrics suggest need for added Medicare payment, MedPAC says
Hospital metrics suggest FY26 Medicare payment should increase by more than what’s provided in the statutory formula, according to a formal recommendation by the Medicare Payment and Advisory Commission (MedPAC). Beneficiary access to care appeared to be strong in 2023, the latest year for which data was available, but quality indicators were mixed, according to…
Trump administration keeps up the fight on 340B, Inflation Reduction Act concerns
The issue of drug pricing is proving to be an area of harmony and continuity between the Trump and Biden administrations, at least for now. In recent days, the Trump administration moved to defend the Biden administration’s stance in opposition to drug manufacturers that are looking to offer 340B Drug Pricing Program discounts through a…
Trump administration charts a new course at the Center for Medicare & Medicaid Innovation
The Trump administration has started to streamline the portfolio of alternative payment models sponsored by the Center for Medicare & Medicaid Innovation (CMMI), recently announcing the early expiration of four models. CMS said the decision resulted from an assessment of whether the models could meet statutory criteria to be expanded into the full Medicare program.…