Healthcare Payers / Providers

Senate HELP Chairman Bill Cassidy’s (R-LA) recently introduced 340B Drug Pricing Integrity and Affordability for Patients Act raises threats to 340B contract pharmacies (both brick-and-mortar and mail-order) [CVS and private Walgreens, and to a much…

CMS’s CY27 proposed Medicare end-stage renal disease (ESRD) payment rule is likely to leave dialysis providers [DVA, FRE.DE, private Innovative Renal] somewhat disappointed. The agency declined to extend the transitional drug add-on payment adjustment (TDAPA)…

CMS informed Medicare Advantage (MA) insurers [HUM, UNH, CVS, ELV, CNC, ALHC, MOH, CLOV] that it is voluntarily recalculating their CY26 Star Ratings, which determine CY27 Quality Bonus Payments (QBP). Under the agency’s approach, released…

Last week’s ACA-related court ruling permanently, which enjoined key portions of the CY25 Obamacare regulation, may initially reassure insurers [OSCR, CNC, ELV] and hospitals [HCA, THC, CYH, UHS, ARDT] about certain enrollment-related program integrity headwinds….

While Medicaid and ACA enrollment concerns have dominated the policy overhang for hospitals this year, Medicare-related risks could move higher on investors’ radar with the release of CY27 hospital outpatient prospective payment system (OPPS) proposed…

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…