Dr. Oz describes changes he would bring to Medicare, Medicaid as CMS administrator
April 3 update: The Senate formally confirmed Oz as CMS administrator via a 53-45 party-line vote. He is expected to be sworn in and begin work within days. March 25 update: The Senate Finance Committee voted 14-13 along party lines to send Oz’s nomination to the full Senate for a formal confirmation vote. Democrats voting…
Affordable Care Act marketplace enrollment likely to decrease under proposed regulations
The Trump administration’s first regulations on the Affordable Care Act health insurance marketplaces are projected to reduce enrollment. As announced by CMS on March 10, a soon-to-be-published proposed rule would implement new program integrity standards for the marketplaces. Part of the motivation stated in the rule is to address “a substantial risk of improper enrollment.”…
Medicaid DSH payment cut again delayed in proposed federal funding bill (updated)
March 15 update: The bill has passed both chambers of Congress as originally drafted and described below. Hospitals that receive Medicaid disproportionate share hospital (DSH) payments would get continued relief from a pending big cut, according to the latest proposed FY25 continuing resolution (CR). A scheduled three-year, $24 billion reduction would be delayed through September…
MedPAC March 2025 Public Meeting Summary
HFMA presents a detailed summary of the March 6-7, 2025, MedPAC public meeting.
Injunction granted on policy change that would hamper funding for teaching hospitals
A federal judge has extended a block on a Trump administration policy that would cap reimbursement for indirect medical research costs at institutions such as teaching hospitals. Per the Feb. 7 policy issued by the National Institutes of Health (NIH), add-on payments for facility and administrative expenses as part of research grants would be limited…
Going their own way: Numerous hospitals opt out of Blues settlement
Several large health systems and dozens of other hospitals and healthcare providers are pursuing antitrust litigation against Blue Cross Blue Shield (BCBS) after opting out of a record-setting settlement. Lawsuits are known to have been filed against the insurer in California, Illinois and Pennsylvania federal court since March 4, the deadline for hospitals to opt…
FY 2025 IPPS/LTCH PPS Final Rule Summary
HFMA presents a detailed summary of the final rule published by CMS in the August 1, 2024, Federal Register describing FY 2025 policies and rates for Medicare’s hospital IPPS and LTCH PPS.
Congressional hearing highlights the favored approach to cutting Medicaid funding
A recent hearing of the House Oversight and Government Reform Committee showcased the rationale Republicans will use in pursuing significant Medicaid spending cuts. The Feb. 25 hearing was called to examine various federal programs that made the Government Accountability Office’s (GAO’s) High-Risk List for 2025. Because of the ongoing stakes for Medicaid, much of the…
Settlement participation in Blues litigation may pose concerns for hospitals, attorney says
As the deadline fast approaches for hospitals to decide whether to participate in a record-setting class-action settlement with Blue Cross Blue Shield, competing views of the situation remain. By March 4, hospitals have to alert the settlement administrator if they want to opt out of the $2.8 billion agreement, which also includes injunctive relief said…
Medicaid proponents weigh in as potentially big cuts come under consideration on Capitol Hill
Feb. 26 update: In a vote on the evening of Feb. 25, the House passed the budget resolution. Specifics of the spending cuts will now be drafted by the respective House committees, and the House and Senate will then have to agree on the final bill. Supporters of healthcare providers and consumers are growing increasingly…