Healthcare Payers / Providers

With the November elections less than two months away, we assess how different congressional outcomes could reshape the healthcare legislative agenda for health insurers, pharmacy benefit managers (PBMs), 340B contract pharmacies, and health savings account…

Our review of stakeholder feedback on CMS’s CY27 Medicare payment rule for dialysis centers [DVA, FRE.DE, private US Renal Care and Innovative Renal Care] leaves us expecting a final rule similar to the June proposal,…

The pending Contract Year (CY) 2028 Technical and Policy Changes proposal for the Medicare Advantage (MA) insurers [HUM, ALHC, UNH, CVS, ELV, CNC, CLOV, MOH] and MA-exposed providers [AGL, ASTH] could be relatively more consequential…

Through 2028, Obamacare enrollment faces two statutory headwinds after the large, still unfolding 2026 reset: The 2027 narrowing of ACA subsidy eligibility for certain non-citizens. The 2028 installation of pre-enrollment subsidy eligibility verification. For exchange…

The FY27 Medicare inpatient hospital (IPPS) final rule was modestly more favorable than the proposal for acute care hospitals [HCA, THC, CYH, ARDT, UHS, MPT, muni-backed systems], increasing CMS’s projected aggregate payment increase by $1B….

Final FY27 Medicare reimbursement rules for hospices [CHE, ADUS, PNTG, BTSG, AVAH, Gentiva, Compassus, Elara], inpatient rehab facilities (IRFs) [EHC, Select Medical, Kindred], and inpatient psych facilities (IPFs) [UHS, ACHC], were largely in line with…

CMS’s final FY27 Medicare skilled nursing facility (SNF) reimbursement regulation, which was released late Wednesday, was largely uneventful and in line with expectations for SNF operators [ENSG, PACS] and related REITs [SBRA, OHI, LTC, CTRE]….

Tuesday’s CMS release detailing the financial components of its CY27 standalone Medicare Part D program and its decision to sunset the related two-year Part D Premium Stabilization Demo suggest additional uncertainty for standalone Part D…

We think the July 28 federal court hearing on the 25 states and the District of Columbia’s request to preliminarily enjoin CMS’s interim final rule (IFR) for Medicaid community engagement (CE) requirements for the Medicaid…

CMS’s proposed CY27 Medicare Physician Fee Schedule (PFS) includes an expected decrease in aggregate Medicare spending of $2.1B and up to a ~1.7% cut in the conversion factor (i.e., base rate) due to the expiration…