Healthcare Payers / Providers

With the August recess in full swing for the next few weeks, the various healthcare-related legislative items on Congress’s to-do list (see below) remains lengthy for the rest of the calendar year. We are still…

Medicare’s final FY26 payment regulations for hospices [CHE, AMED, ADUS, PNTG, BTSG, Gentiva, Compassus, Elara], inpatient rehab facilities (IRFs) [EHC, SEM], and inpatient psych facilities (IPFs) [UHS, ACHC] aligned with expectations for: 1) slightly higher aggregate spending…

Medicare’s final FY26 payment regulations for inpatient hospitals [HCA, THC, CYH, ARDT, UHS, MPW, municipal bond-backed facilities], long-term care hospitals (LTCHs) [SEM, Kindred], and skilled nursing facilities (SNFs) [ENSG, PACS, Providence] with implications for their post-acute…

Against the backdrop of positive Q2 earnings, upward full-year guidance, and voiced confidence in the ability to manage the medical cost and utilization trends throughout 2H and into next year, we think the recently refiled…

Today’s CMS release regarding its CY26 Medicare Part D program gives  the impression the agency is focusing on stability in its drug benefit program with the goal to ensure 1) enrollees – especially those in…

While exchange insurers (OSCR, CNC, ELV) and hospitals (THC, CYH, ARDT, UHS, HCA) try to figure out their  Obamacare businesses for next year with the various regulatory and reconciliation-related changes leading to anticipated enrollment declines…

Hospitals [CYH, ARDT, UHS, THC, HCA] were on the losing end of the stick under CMS’s proposed CY26 Medicare reimbursement rule for hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) for a variety of…

While Monday night’s proposed CY26 Medicare Physician Fee Schedule (PFS) provides an annual rate increase for physicians of 3.3%+ compared to cuts during prior years, closer examination of the proposal reveals some potential reimbursement headwinds…

While we still agree with consensus about the negative bias towards hospitals and Medicaid insurers from the One Big Beautiful Bill Act (OBBA) signed into law last Friday, we note a few tweaks in the…

CMS’s addition last week of 300+ Medicare Advantage (MA) [UNH, HUM, CNC, ELV, CVS, ALHC] contracts to be audited for risk adjustment data verification (RADV) during plan year (PY) 2019 raises the risk of larger…