Articles and Blogs

The Centers for Medicare & Medicaid Services’ (“CMS’s”) guidance governing Medicare Advantage marketing practices has continued to evolve over the past several years, with regulatory requirements shifting significantly across administrations. These changes reflect both the ongoing development of health care coverage models and differing policy priorities among governing parties. As a result, organizations involved... READ MORE

On May 22, 2026, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule regarding both Medicaid State directed payments (“SDPs”) and Medicaid fee-for-service reimbursement. The proposed rule is based on two distinct but reinforcing authorities: (i) section 71116 of H.R. 1 (a/k/a the “One Big Beautiful Bill Act”); and (ii) the... READ MORE

In April, the Centers for Medicare & Medicaid Services (“CMS”) released the FY 2027 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”) to update IPPS payment rates and uncompensated care payments, refine CMS’s definition of new GME residency programs, request input on new quality measures, expand the joint replacement payment model, CJR-X, on... READ MORE

On April 14, 2026, the Centers for Medicare & Medicaid Services (“CMS”) published the fiscal year (FY) 2027 Inpatient Prospective Payment System (IPPS) proposed rule (the “Proposed Rule”) in the Federal Register, which included several proposals that would affect organ acquisition reimbursement policies for Independent Organ Procurement Organizations (“IOPOs”), as well as Organ Procurement... READ MORE

Congress recently enacted the Consolidated Appropriations Act of 2026, which includes new Medicare conditions of payment for off-campus hospital outpatient departments. Beginning January 1, 2028, Medicare payments will not be made for items and services furnished by an off-campus department unless the hospital satisfies new requirements related to location-specific National Provider Identifiers (“NPIs”) and... 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 Centers for Medicare & Medicaid Services (“CMS”) has released the Calendar Year 2026 Hospital Outpatient Prospective Payment System Final Rule, which includes another round of substantial updates to the Hospital Price Transparency (“HPT”) regulations. The new policies aim to further standardize the data disclosed by hospitals, enhance the utility of the machine-readable files... READ MORE

On November 14, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued a letter, which it describes as “preliminary guidance,” concerning two significant restrictions on Medicaid provider taxes set forth in H.R. 1, including: (i) a change in the indirect hold harmless threshold for provider taxes—which, in effect, prohibits states from increasing the... READ MORE

On October 31, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year (“CY”) 2026 Medicare Physician Fee Schedule (“MPFS”) final rule (“Final Rule”), announcing finalized policy changes for Medicare payments under the MPFS and other Medicare Part B (“Part B”) issues, effective on or after January 1, 2026. The Final... READ MORE