Aetna delays and modifies new policy that’s set to hit reimbursement for inpatient hospital stays
Hospitals received a brief reprieve from a pending Aetna payment policy that remains likely to decrease reimbursement starting in 2026. In a prior announcement, Aetna said it would apply level-of-severity criteria to all urgent or emergent hospital admissions lasting at least one midnight for Medicare Advantage (MA) and Medicare Special Needs Plans patients. For stays…
Government funding deal would extend key healthcare programs but not Affordable Care Act enhanced subsidies
Note: This article has been updated with additional comments from members of Congress. Important healthcare funding could be restored in a matter of days, with an agreement to end the government shutdown now in sight. The Senate struck a deal Nov. 9 to advance a federal funding bill for a formal vote, with eight Democrats…
In annual rule, CMS finalizes new regulatory curbs on Medicare physician payments
Medicare has cued up its first physician payment increase in six years, but policy changes will bring new financial constraints for hospital-based physicians and many specialties. A 2026 final rule ushers in limitations on payments for a wide array of physicians. After factoring in budget neutrality requirements, the policies appear to boost independent primary care…
The shutdown continues, plus the latest on 340B
HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the latest in healthcare finance news.
Senate hearing on 340B reflects congressional interest in altering the program
A leading healthcare policymaker in Congress sounds intent on modifying the 340B Drug Pricing Program. Sen. Bill Cassidy (R-La.), chair of the Senate Committee on Health, Education, Labor and Pensions (HELP), led a 340B-focused hearing Oct. 23 during which he called for changes. “If this committee is serious about making healthcare more affordable, about making…
Oct. 20: Where things stand with the government shutdown and Affordable Care Act subsidies
HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the latest in healthcare finance news.
The healthcare payroll hit stemming from termination of the Affordable Care Act enhanced subsidies
Healthcare providers would be at risk of losing more than 150,000 jobs in 2026 if the higher Affordable Care Act (ACA) marketplace subsidies expire at the end of this year, according to a new analysis. In the analysis published by the Commonwealth Fund, researchers used economic modeling to project that providers would lose 154,000 jobs…
Oct. 6, 2025: The healthcare impacts of a federal government shutdown
HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the latest in healthcare finance news.
No Surprises Act arbitration has been a bonanza for a few provider groups
In a span of 2.5 years through 2024, providers reaped more than $2.2 billion from the No Surprises Act’s arbitration process, relative to the applicable in-network payment rates for the disputed care episodes. The awards received through the NSA’s independent dispute resolution (IDR) process largely arise from “disputes that are primarily initiated and won by…
HFMA Comments on CY 2026 Hospital OPPS and ASC Proposed Rule
HFMA submits comments to CMS pertaining to CMS-1834-P CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Proposed Rule.