Reimbursement

Trump proposes big spending cuts to healthcare programs

President Donald Trump’s FY26 budget proposal includes significant cuts to healthcare programs, but the administration says the reductions will not affect core services. The budget is merely a set of recommendations, given that federal budgetary authority resides with Congress. Trump’s proposals are likely to hold influence with the narrow Republican majorities in both chambers, but…

By Nick Hut May 2, 2025

Blue Cross Blue Shield settlement concerns linger as date of final approval nears

Nearly 15,500 healthcare providers are known to have withdrawn from the record-setting Blue Cross Blue Shield antitrust settlement, retaining the option to pursue separate litigation. The number was listed in an April court filing as the parties move toward a July 29 hearing at which the presiding court is scheduled to consider final approval of…

By Nick Hut May 1, 2025

Supreme Court: HHS can maintain DSH formula approach that results in lower payments

The Supreme Court dealt hospitals a loss in a case about Medicare disproportionate share hospital (DSH) payments, saying HHS can continue using a disputed interpretation of the payment formula. Published April 29, a 7-2 decision for the federal government in Advocate Christ Medical Center, et al. v. Kennedy allows for continuation of a policy whereby…

By Nick Hut April 29, 2025

FY 2026 Inpatient Psychiatric Facilities PPS Proposed Rule Summary

HFMA presents a detailed summary of the FY 2026 Inpatient Psychiatric Facilities PPS proposed rule, released by CMS on April 11, 2025.

By HFMA April 29, 2025

Upcoming regulations and budget talks could be consequential for Medicaid supplemental payments

Note: This article was updated May 2. The system of directed payment programs (DPPs) has helped make Medicaid more financially viable for providers, but that system is under increasing political pressure. CMS has queued up a proposed rule that is undergoing a standard review at the Office of Management and Budget (OMB) and then is…

By Nick Hut April 28, 2025

8 best practices for elevating and integrating RA in value-based care

As healthcare organizations work toward meeting CMS’s 2030 implementation goals for value-based care (VBC), RA should be a top concern. Too often, these organizations’ leaders mistakenly believe all that’s needed for success under VBC is to invest in a strong coding department. Many healthcare executives and clinical leaders understand the importance of RA, but they…

By Gabrielena Alcala April 25, 2025

340B changes loom as the program attracts congressional, White House scrutiny

Both Congress and the White House are proposing 340B Drug Pricing Program changes that could add administrative burdens and ultimately limit the available savings for hospitals. A new report issued by Republican members of the Senate Health, Education, Labor and Pensions (HELP) Committee calls for changes that include requiring 340B covered entities to “provide detailed…

By Nick Hut April 25, 2025

FY 2026 IPPS/LTCH PPS Proposed Rule Summary

HFMA presents a detailed summary of the proposed rule describing FY 2026 policies and rates for Medicare’s IPPS and LTCH PPS.

By HFMA April 23, 2025

2026 Medicare Advantage – Part D Final Rule Summary

HFMA provides a detailed summary of the final rule revising regulations affecting Medicare Advantage, Medicare Prescription Drug Benefit, Medicare cost plans, and Programs of All-Inclusive Care for the Elderly.

By HFMA April 21, 2025

CMS seeks feedback on applying MAHA guidelines in the U.S. healthcare system

The Medicare FY26 proposed rule for hospital inpatient payments offers clues as to how the Trump administration will seek to integrate principles of the Make America Healthy Again (MAHA) movement in the healthcare infrastructure. The rule includes a request for information (RFI) on using mandatory hospital quality measurement to foster improvements in nutrition and physical…

By Nick Hut April 17, 2025
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