Policy Updates

Non-Profit Hospitals Struggled in 2025, Moody’s Finds

The financial performance of non-profit hospitals weakened in 2025, according to Moody’s, the financial rating service company. According to Moody’s: Median operating margins fell from 1.3 percent in 2024 to 1.2 percent in 2025. Median operating income fell 13.3 percent. Revenue growth fell from 9.6 percent to 8.9 percent. Expenses continued to grow, driven by increased wages and rising costs for purchased services and prescription drugs. On the other hand, Moody’s also found that: Revenue growth outpaced rising expenses. Patient and pharmacy activity grew. Hospitals in some states benefited from expanded Medicaid supplemental payments. Commercial reimbursement improved. For a closer [...]

joe2026-08-18T14:42:20-04:00August 20, 2026|hospitals, Medicaid|

Analysis Puts Price Tag on Loss of Medicaid State Directed Payments

Thirty-seven states face the loss of significant federal Medicaid revenue depending on how the Centers for Medicare & Medicaid Services ultimately implements a provision in the 2025 reconciliation bill that called for new limits on so-called state directed payments – Medicaid money the states direct to their Medicaid managed care plans with instructions on how to use that money. The 2025 law calls for nearly a trillion dollars in reduced federal Medicaid spending and $60 billion of that cut could result from new limits on state directed Medicaid payments to managed care organizations. Providers in eight states, led by California, [...]

joe2026-08-18T16:49:35-04:00August 19, 2026|Congress, hospitals, Medicaid|

Mandatory Value-Based Programs Increase Hospital Costs

While policymakers continue to pursue mandatory Medicare value-based programs at least in part to help reduce taxpayers’ costs for Medicare, they may be robbing Peter to pay Paul. According to a new study, hospitals that participate in federally mandated Medicare value-based purchasing programs face increased administrative costs for doing so even while federal agencies maintain that the programs are saving taxpayer money. Brown University researchers examined 15 years of hospital cost reports and found that participation in Medicare’s Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, and Hospital-Acquired Condition Reduction Program cost hospitals about $650,000 a year in added administrative [...]

joe2026-08-13T16:41:29-04:00August 17, 2026|hospitals, Medicare|

Court Rejects No Surprises Act’s QPA Methodology

A federal appeals court has rejected how health care payers calculate their qualifying payment amount, or QPA, when addressing disputed payments under the No Surprises Act’s Independent Dispute Resolution process. The QPA is the central benchmark rate payers present to help settle out-of-network medical billing disagreements that for years led to surprise medical bills for many hospital patients. The court concluded that payers should not be permitted to include so-called ghost rates when calculating their QPA; a ghost rate is a rate for services that a given provider does not actually provide, leaving the provider no incentive to attempt to [...]

joe2026-08-13T15:13:04-04:00August 14, 2026|Uncategorized|

Federal Health Policy Update for August 13

Don’t Miss: Federal court vacates key aspect of No Surprises Act’s IDR process President calls for changes in childhood immunizations CMS seeks billing info so it can pay APM docs their bonuses The following is the latest health policy news from the federal government for August 7-13. Some of the language used below is taken directly from government documents. The White House The White House has issued an executive order calling for a change in recommended childhood vaccines. The order suggests reducing the number of recommended childhood vaccines from the current 17 to 11 revising the status of the remaining [...]

joe2026-08-13T14:39:23-04:00August 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

CMS Clarifies Upcoming IDR Changes

Earlier this year, the departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management published federal Independent Dispute Resolution operations final rules to improve the functioning of the No Surprises Act’s IDR process, which is part of a broader effort to eliminate surprise medical bills. The new rules seek to streamline communication between health care payers, providers, and certified IDR entities by establishing new timelines and processes. When the individual requirements in these final rules will take effect will vary depending on when the technical capacity to support them is ready within the not-yet-introduced [...]

joe2026-08-12T13:05:25-04:00August 13, 2026|Uncategorized|

Disagreement Over 340B’s Future

Almost immediately after the Department of Health and Human Services announced a pilot program to test using a rebate model in the 340B Drug Pricing Program, members of Congress responded with proposed legislation that would prevent HHS from implementing that pilot. Last week, HHS’s Health Resources and Services Administration announced its 340B Rebate Model Pilot Program, a refined version of a previous pilot program that a federal court rejected earlier this year. Under this new model, qualifying drug manufacturers will be able to provide the 340B ceiling price to eligible 340B providers through rebates, an approach manufacturers have increasingly sought, [...]

joe2026-08-11T15:58:28-04:00August 12, 2026|340b, hospitals|

HRSA Tries Again With New 340B Model

Following a federal court rejection earlier this year of a previously announced pilot program to alter how the 340B Drug Pricing Program is administered, the Department of Health and Human Services’ Health Resources and Services Administration has announced that it will implement a revised 340B Rebate Model Pilot Program. Under this new model, qualifying drug manufacturers will be able to provide the 340B ceiling price to eligible 340B providers through rebates, an approach manufacturers have increasingly sought, rather than the upfront discounts that providers prefer. According to a HRSA news release, the agency believes its new model will: Improve claims-level [...]

joe2026-08-06T15:15:39-04:00August 10, 2026|340b|

Loss of Insurance Options Hitting Hospital Bottom Lines

Hospitals are starting to feel the impact of the loss of enhanced subsidies for the purchase of Affordable Care Act health insurance plans. According to officials from a number of for-profit hospital companies, they have been surprised at how few patients who lost their Affordable Care Act enhanced premium subsidies have purchased alternative coverage, leaving them uninsured instead. Nearly three million fewer people purchased insurance through Affordable Care Act exchanges this year than last year. Such individuals continue to turn to hospitals for care – increasingly, for care they put off because they were uninsured, resulting in greater acuity. Hospitals [...]

joe2026-08-05T12:54:53-04:00August 7, 2026|Affordable Care Act, hospitals|

Federal Health Policy Update for August 6

The following is the latest health policy news from the federal government for July 31 to August 6. Some of the language used below is taken directly from government documents.CongressThe Senate is expected to vote on its version of a continuing resolution (CR) before leaving for recess; it would extend federal government funding through December 11. Notably, the legislation includes language that would prevent the Office of Management and Budget from moving forward with its proposed change in how federal grants are awarded and overseen.Because appropriations bills have not cleared both chambers of Congress, the federal government faces a September [...]

joe2026-08-17T15:33:55-04:00August 6, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|