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Last week’s federal court ruling in favor Clover Health (CLOV) against CMS injects fresh uncertainty into the Medicare Advantage (MA) Star Ratings and quality bonus payment framework [UNH, HUM, ELV, CVS, ALHC, CNC, MOH]. While…

The House and Senate are both in session this week, but the market-relevant question is less about what Congress does over the next couple of weeks and more about how much time Republicans waste before…

This morning’s final rule revising operations of the No Surprises Act (NSA) federal independent dispute resolution (IDR) process does not seem to upset the balance that has favored certain out-of-network specialist physicians and hospitals [NUTX,…

With Noridian (17% of services) including instructions that physicians bill for Inspire Medical’s (INSP) Inspire V procedure with a -52 (reduced work / payment) modifier this morning, following a similar update from WPS on May…

We wanted to give you and update on two bills in the California legislature, impacting META, GOOGL, SNAP, STUB, and LYV, that we have been following and which we expect to be considered on the…

Following last week’s draft LCDs requiring Glaukos (GKOS) iDose patients to first fail ≥ 2 topical medications and selective laser trabeculoplasty (SLT), the absence of reliable data on the proportion of existing patients that can…

CMS’s long-awaited proposed rule implementing the One Big Beautiful Bill’s (OBBB) restrictions on state directed payment programs (DPPs) pushes the envelope a bit further than the statute itself, particularly for hospitals [HCA, THC, CYH, UHS,…

The draft local coverage decision (LCD) issued today by five MACs with jurisdiction over ~70% of Glaukos (GKOS) Medicare FFS volumes is both better and worse than we had anticipated for the company’s growing iDose…

We expect AB 1720, the California Fans First Act, which would prohibit a ticket reseller (STUB, LYV) from selling or facilitating the sale of a covered ticket for more than the original price plus 10%,…

Two long-anticipated hospital-specific Medicaid state directed payment programs (DPPs) in Florida and Indiana, benefitting HCA, CYH, and THC and other hospitals in those states, appear to have been approved by CMS in recent weeks, according…