Healthcare Payers / Providers

CMS’s long-awaited interim final rule implementing the One Big Beautiful Bill’s (OBBB) Medicaid Community Engagement (CE) requirements largely aligns with our expectations that CMS would defer to states on program design and implementation, which we…

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…

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,…

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,…

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…

CMS’s announcement of a six-month moratorium on new hospice and home health agency enrollment in Medicare is the latest escalation in the administration’s broader crackdown on alleged waste fraud, and abuse, reinforcing its ongoing targeting…

UNH’s new Optum Rx model, which shifts PBM and group purchasing organization compensation in its commercial business toward transparent flat fees, appears designed to modestly outpace similar transparency initiatives from CI and CVS while aligning…

With 1Q26 earnings now largely complete for the major Medicare Advantage (MA) insurers [UNH, HUM, ALHC, CVS, ELV, CNC, MOH], near-term MA policy risks remain less acute, though far from extinguished. Congressional cuts remain unlikely…

A wave of state actions (AR, IA, ID, IN, MO, MT, NC, NE, NH) on Medicaid community engagement requirements (aka work requirements), spanning both accelerated implementation like today’s launch in NE and in some cases,…

With the CY27 Medicare end-stage renal disease (ESRD) payment proposal now under OMB review, uncertainty surrounding the extra payments for oral phosphate binders to dialysis centers [DVA, FRE.DE, private Innovative Renal] may emerge as an…