Articles and Blogs

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

On January 16, 2026, the Department of Justice (“DOJ”) announced that it recovered a record-breaking $6.8 billion in False Claims Act (“FCA”) related settlements and judgments in the 2025 fiscal year. The 2025 recovery amount more than doubles the previous year’s recovery of $2.9 billion and marks the highest recovery in a single year... READ MORE

Congress’s fiscal year 2026 health care appropriations bill introduces a significant new statutory condition of Medicare payment for off-campus hospital outpatient departments. If enacted, effective January 1, 2028, Medicare payment would be prohibited for items and services furnished by an off-campus hospital outpatient department unless two conditions are met: (1) the department has a... READ MORE

On January 21, 2026, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released its Semiannual Report to Congress for the six-month period ending September 30, 2025 (“Report”). OIG’s enforcement actions during this period resulted in “the largest health care fraud takedown in the Department of Justice history, involving more... READ MORE

Amendments to the Illinois Workplace Transparency Act (“WTA”) were introduced by HB 3638 and became effective on January 1, 2026. The amendments broaden the scope of protection for employees and impose additional restrictions on employers when drafting contract provisions in a variety of employment-related agreements, including severance, settlement and arbitration agreements. Going forward, Illinois... READ MORE