Bulletin Board
Bulletin Board
Developments in No Surprises Act/Independent Dispute Resolutions
Recent weeks have seen several developments and new information in the use of the No Surprises Act’s independent dispute resolution process for health care billing disputes between payers and providers over out-of-network care. The number of disputes directed to independent dispute resolution continues to rise – 16 percent more during the second half of 2025 than during the first half of that year. Providers continue to initiate about three-quarters of the disputes and to win about 85 percent of those cases. Most of the provider-driven disputes are intiated by small [...]
CMS Proposes Medicaid Provider Tax Regulation
The Centers for Medicare & Medicaid Services has published a proposed rule that would implement a portion of H.R. 1, last year’s federal budget reconciliation bill, that called for establishing new indirect hold-harmless thresholds for health care-related taxes – primarily, provider taxes, which are currently employed in 49 states and the District of Columbia. Major changes include: Replacing the six percent safe harbor with state-specific thresholds based on July 4, 2025 structures. Prohibiting states from introducing new Medicaid provider taxes or increasing existing provider taxes that were in effect [...]
Federal Health Policy Update for July 23
Don’t Miss: Congress advances health care bills CMS proposes provider tax rule Courts act on ACA changes, 340B The following is the latest health policy news from the federal government for July 17-23. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee held a markup for 29 bills, advancing the following health care transparency measures with bipartisan support: H.R. 9390, Prices on the Wall Act of 2026 H.R. 9393, Lower Costs, More Transparency Act of 2026, part of a [...]
Court Pauses Parts of ACA Rule
A federal court in Maryland has issued a temporary stay in the implementation of eight provisions in CMS’s Affordable Care Act marketplace rule – provisions that were to take effect on July 20. In a challenge to the legality of portions of the regulation in the case of City of Columbus v. Kennedy, the court concluded that the plaintiffs were likely to succeed in their challenge to some provisions in question even before further proceedings and therefore vacated: the expansion of eligibility for catastrophic plans through an income-based hardship exemption; [...]
CMS Touts ACO REACH Model Results
An evaluation commissioned by the Center for Medicare and Medicaid Innovation has found that the agency’s Medicare ACO REACH (Realizing Equity, Access, and Community Health) Model is saving money and improving health care outcomes. A summary of an evaluation of the program’s 2023 performance year explained that The ACO REACH Model is an advanced accountable care organization (ACO) initiative to promote patient-centered care, lower costs, and align payment systems for Original Medicare beneficiaries through ACO risk-sharing and prospective payment. In performance year (PY) 2023, the model showed stronger improvements in [...]