Articles and Blogs

Effective January 1, 2026, the Centers for Medicare & Medicaid Services (“CMS”) implemented significant changes to the accreditation and enrollment framework for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) suppliers through the CY 2026 Home Health Prospective Payment System Final Rule (“Final Rule”). CMS adopted these changes in response to what it describes... READ MORE

Federal courts are showing diminishing tolerance for perpetual False Claims Act (“FCA”) litigation. Years-long seal periods, one-sided discovery and serial amendments are wearing thin. The Fifth Circuit’s recent decision in United States ex rel. Gentry v. Encompass Health Rehabilitation Hospital of Pearland, L.L.C., 157 F.4th 758 (5th Cir. 2025) (“Gentry“) reflects this shift and... READ MORE

NATIONAL 4 Joint Commission moves in January AMA alters position on gender-affirming surgeries for minors Cardiovascular care demand fuels investments from hospitals Cigna CEO predicts steady PBM margins amid settlement, health law CMS makes ‘huge’ shift emphasizing falls in Special Focus Facility selection process CMS proposes paying hospitals that buy US-made drugs, supplies CMS... READ MORE

The Indiana Court of Appeals (the “Court”) recently affirmed a trial court’s finding of grave disability, reiterating two settled principles: (1) no single fact can establish grave disability; and (2) courts must evaluate the totality of the circumstances. The Court also confirmed that past conduct with a nexus to the patient’s current condition may... READ MORE

On February 3, 2026, after years of false starts, federal regulation of pharmacy benefit managers (“PBMs”) became reality when the Consolidated Appropriations Act, 2026 (the “Act”) was signed into law by President Trump. For the first time, the Act imposes federal requirements on PBMs related to compensation, transparency, reporting and other matters to be... READ MORE

On February 2, 2026, the Centers for Medicare & Medicaid Services (“CMS”) released a new guidance letter (“February 2 Letter”) regarding state directed payments (“SDPs”) as governed by Section 71116 of Public Law 119-21 (which CMS refers to as the “Working Families Tax Cuts” or “WFTC legislation”). Per CMS, its previous September 9, 2025,... READ MORE

On February 2, 2026, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule, effective April 3, 2026, that targets a perceived “loophole” in the current regulatory statistical test applied to State proposals for health care-related tax waivers. The test is intended to make certain that non-uniform or non-broad-based health care-related taxes,... READ MORE

The upcoming National Resident Matching Program is expected to be affected by several recent immigration-related developments under the Trump administration that employers should incorporate into their match planning strategy, including nationality-based travel restrictions, the U.S. Citizenship and Immigration Services (“USCIS”) adjudication pause and the $100,000 fee for new H-1B petitions filed on behalf of... READ MORE

On January 30, 2026, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule that would substantially revise portions of the Conditions for Coverage for Organ Procurement Organizations (“OPOs”) (the “Proposed Rule”). According to CMS, the Proposed Rule is characterized as building on changes in the 2020 OPO Conditions for Coverage rule... READ MORE

NATIONAL Children’s Hospital Association teams with Vizient CMS official defends flat Medicare Advantage rate proposal for 2027 CMS pitches stricter oversight of organ procurement groups: 6 takeaways CMS proposes nearly flat Medicare Advantage payments for 2027: 5 notes CMS proposes excluding chart reviews from MA risk scoring in 2027 payment rule CMS seeks input... READ MORE