Senate version of the budget reconciliation bill does not look promising for providers
Note: The lead section of this article was updated June 17 with clarifying information on state-directed payments. As released late Monday afternoon, the Senate Finance Committee’s healthcare proposals that would be part of the budget reconciliation bill go beyond the House bill in constraining Medicaid spending. Key changes from the version passed by the House…
Indiana law with big implications for hospital pricing may be a bellwether
A landmark hospital pricing bill that recently became law in Indiana could foreshadow similar developments in other states. Indiana hospitals will face both a tax penalty and the loss of their tax-exempt status if their prices exceed designated limits. The limits, to be determined via a formula set by the state’s Office of Management and…
Why Medicare Advantage provisions could end up in the budget reconciliation bill
This article was updated June 12. According to early discussions in the Senate, a final version of the budget reconciliation bill could reduce the amount of federal spending in Medicare Advantage (MA). The Senate is considering whether to modify the reconciliation bill passed by the House, and one topic of conversation is how to achieve…
More details on HHS budget proposals for FY26
An updated version of President Donald Trump’s FY26 budget request to Congress includes new information on how proposed spending cuts would affect HHS and its subsidiary agencies. As described in a summary, the request calls for “radical change” to improve the performance of the U.S. healthcare system, reiterating previously reported ideas for shrinking and restructuring…
CMS announces process change for short-stay inpatient claim reviews in Medicare
Recent CMS directives for hospitals include a process change regarding Medicare patient status reviews. Beginning Sept. 1, Medicare administrative contractors (MACs) will conduct the reviews used to determine the appropriateness of Part A payment for adjudicated short-stay inpatient hospital claims. The reviews to date have been conducted by Beneficiary and Family Centered Care Quality Improvement…
House passes budget reconciliation bill that would dramatically affect healthcare coverage
June 10 update: The article was updated with news from the White House about Medicaid state-directed payments. June 4 update: The article was updated with the Congressional Budget Office’s formal score of the legislation passed by the House. A sweeping federal policy bill that includes major changes to Medicaid is halfway toward becoming law after…
Budget reconciliation bill faces a rocky road as Medicaid and ACA cuts draw provider concerns
In the days after a key House committee approved legislation that includes substantial cuts to Medicaid funding, the bill’s path forward remained full of obstacles. The healthcare portion of the budget reconciliation bill passed the Energy and Commerce Committee on a party-line 30-24 vote May 14. Since then, reports from Capitol Hill have detailed the…
RFK Jr. defends HHS budget to Congress and talks Medicaid, 340B and more
In congressional testimony, HHS Secretary Robert F. Kennedy Jr. endorsed proposed Medicaid cuts as affecting fraud, waste and abuse rather than beneficiaries who most need the program. Speaking May 14 before a House Appropriations subcommittee and later the Senate Health, Education, Labor and Pensions (HELP) Committee, Kennedy also indicated a willingness to pare down the…
Medicaid provider payments take a hit in budget reconciliation bill
As released over the weekend, formalized plans to reduce federal Medicaid spending would have an impact on future state-directed supplemental payments and other aspects of the program. The House Energy and Commerce (E&C) Committee published its portion of a budget reconciliation bill that would slash 10-year projected federal spending. As expected, Medicaid would incur the…
Providers, payers both struggle with Medicare Advantage challenges
Note: This article was updated May 13 where noted. Neither providers nor a leading payer are finding much reason for satisfaction with the state of Medicare Advantage (MA) these days. Q1 financial reporting by for-profit hospital chains and by UnitedHealth Group (UHG), among other payers, have reflected the challenging landscape. UHG in April shared what…