July 1, 2025
[AMED, PNTG, EHAB, ADUS, BTSG]: Medicare Home Health Rates Worse Than Expected
Home health agencies [AMED, PNTG, EHAB, ADUS, BTSG, AVAH, UNH] received a negative surprise late Monday with CMS seeking to cut Medicare home health aggregate spending by 6.4% for CY26. The agency’s proposal to impose…
June 30, 2025
Healthcare and Reconciliation: Where Things Stand Amid Floor Debate
We expect the Senate to pass the reconciliation bill within the next 24 hours, despite the current reconciliation drama (parliamentarian rulings, CBO projection of deficits post-2034, Senator Thom Tillis’s (R-NC) retirement announcement, House member opposition,…
June 26, 2025
Hospitals, Obamacare, Medicaid: Parliamentarian Decisions Likely to Force Rewriting on Provider Tax, Uncertain about CSR and Enhanced FMAP Policies
The sizable hole left by the Senate parliamentarian decisions on various Medicaid and Obamacare provisions, which were reported this morning by Senate democrats (here and here) injects uncertainty for hospitals, Obamacare insurers, Medicaid managed care,…
June 23, 2025
Home Health: Potential Substance of Upcoming CY26 Medicare Rate Proposal [AMED, PNTG, BTSG, ADUS, AVAH]
In the upcoming CY26 Medicare payment proposal for home health (HH) agencies [AMED, PNTG, BTSG, ADUS, AVAH, UNH], which we expect within the next two weeks based on historical patterns, we think it is more…
June 22, 2025
Obamacare: Program Integrity Rule Meets Overall Expectations, Though Relative Slight Improvement; Risk Remains
Amidst the behind-the-scenes Senate debate of its draft reconciliation bill, CMS made good on its threat to jettison improper and fraudulent Obamacare enrollment, impacting ACA insurers [OSCR, CNC, ELV, MOH] and hospitals / behavioral facilities…
June 17, 2025
Healthcare: Thoughts on the Senate Finance Draft’s Healthcare Provisions
The Senate Finance Committee’s (SFC) draft healthcare and tax portion of the reconciliation bill makes some changes, relative to the House-passed measure, but is overall consistent with that version, with the implications being lower Medicaid…
June 16, 2025
Medicare Advantage: Filling in RADV Blanks; HUM Has Most Contracts Targeted [HUM, UNH, CVS, ELV, CNC, ALHC]
Late Friday, CMS announced the latest list of Medicare Advantage (MA) contracts to be targeted for risk adjustment data verification (RADV) audits – this time for payment year (PY) 2019 – and its associated processes…
June 13, 2025
PBMs: State Legislative Risks Persist Through Session Ends [CI, CVS, UNH, HUM, ELV, Navitus]
With many 2025 state legislative sessions having concluded, pharmacy benefit managers (PBMs) have – for the moment – successfully avoided various bills seeking to aggressively curb industry practices, except for a few new laws in…
June 8, 2025
[HCA, THC, CYH, hospitals] White House Memo Adds Another Wrinkle to State-Directed Payment Programs in Medicaid
A new complication has arisen for hospitals [HCA, THC, CYH, ARDT, UHS, non-profit / municipally-backed facilities] – and to a lesser extent nursing homes, behavioral providers, and certain physicians – in the debate over payment…
June 6, 2025
Thoughts on Medicare Savings Ideas in Reconciliation
Yesterday’s news reports that Senate Republicans are considering and discussing Medicare savings policies to add to the reconciliation bill for lowering the overall deficit and/or filling any potential hole from softening some of the House’s…