Jeffrey Davis on Medicare

The ongoing saga of the PFS conversion factor: will it get fixed?

July 2, 2025 – There has been a lot of talk recently about the future of the Medicare Physician Fee Schedule (PFS) conversion factor (CF) – the standardized dollar amount used to convert relative value units (RVUs) into...more

7/2/2025 / Centers for Medicare & Medicaid Services (CMS) , Healthcare Reform , Medicare , New Legislation , Payment Systems , Physician Fee Schedule , Physicians , Proposed Legislation , Regulatory Reform

A Deep Dive Into the CMS Program Management FY 2026 Budget Request

As discussed in last week’s Regs & Eggs blog post, the US Department of Health and Human Services (HHS) recently released additional budget documents to support the department’s fiscal year (FY) 2026 discretionary request....more

A Preview of the Preview: Our CY 2026 PFS Proposed Rule Webinar Is Next Wednesday

It’s getting hot outside, which means that the summer regulatory season is almost upon us. In June or July, the Centers for Medicare & Medicaid Services (CMS) will release proposed regs impacting Medicare payments in...more

5/22/2025 / Centers for Medicare & Medicaid Services (CMS) , Healthcare Reform , Medicaid , Medicare , Medicare Access and CHIP Reauthorization (MACRA) , Payment Systems , Physician Fee Schedule , Proposed Legislation , Proposed Regulation , Proposed Rules , Quality Payment Program (QPP) , Regulatory Reform

President Trump Issues Most Favored Nations Drug Pricing Executive Order

While much of Washington, DC’s attention this week has been focused on congressional action around budget reconciliation, including proposed changes to the Medicaid program, the White House also made news with release of a...more

5/15/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Drug Pricing , Executive Orders , Food and Drug Administration (FDA) , Imports , Medicaid , Medicare , Prescription Drugs , Trump Administration

The Missing Puzzle Pieces of the FY 2026 “Skinny” President’s Budget

Last week, the White House Office of Management and Budget (OMB) released its fiscal year (FY) 2026 discretionary funding request to Congress on its President’s Budget webpage. The administration released a “skinny” FY 2026...more

5/8/2025 / Biden Administration , Department of Health and Human Services (HHS) , Federal Budget , Government Agencies , Healthcare Fraud , Healthcare Reform , Medicaid , Medicare , OMB , Regulatory Reform

The First 100 Days: By the Numbers

To state the obvious, a lot has happened in healthcare over the first 100 days of President Trump’s second term. But how much? ...more

5/1/2025 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Executive Orders , Healthcare Reform , Medicaid , Medicare , Regulatory Reform , Regulatory Requirements , Trump Administration

FY 2026 Proposed Rules Are Out! Overview of the IPPS Proposed Rule

Last Friday, the Centers for Medicare & Medicaid Services (CMS) officially launched the health policy community into reg season, releasing in one fell swoop all the fiscal year (FY) 2026 Medicare proposed regulations for...more

4/17/2025 / Centers for Medicare & Medicaid Services (CMS) , Deregulation , Healthcare , Healthcare Facilities , Healthcare Reform , Hospitals , Medicare , Proposed Rules , Regulatory Reform , Regulatory Requirements , Rulemaking Process , Trump Administration

CMS Releases FY 2026 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule

On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2026 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment...more

4/16/2025 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Healthcare Facilities , Hospitals , Medicare , Payment Systems , Proposed Legislation , Proposed Rules , Regulatory Requirements , Reporting Requirements

HHS’s Restructuring: What Happens Next?

Last week, the US Department of Health and Human Services (HHS) announced that it will undergo a major restructuring and plans to eliminate 10,000 employees on top of 10,000 HHS employees who have already departed (20,000...more

4/3/2025 / Affordable Care Act , ATSDR , Centers for Disease Control and Prevention (CDC) , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Employees , Food and Drug Administration (FDA) , Government Agencies , Healthcare Reform , Hiring & Firing , HRSA , Medicaid , Medicare , National Institute of Health (NIH) , NIOSH , Regulatory Reform , SAMHSA

Game On! 2026 Medicare Fee-for-Service Rulemaking Is About to Tip Off

Game On! 2026 Medicare Fee-for-Service Rulemaking Is About to Tip Off - It’s March, which means one thing for sports fans: the madness of the NCAA men’s and women’s basketball tournaments. However, to folks in the...more

3/27/2025 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Healthcare , Healthcare Reform , Hospitals , Medicare , Proposed Rules , Regulatory Agenda , Regulatory Reform , Regulatory Requirements , Trump Administration

2026 Medicare Advantage and Part D Final Rate Notice: What to Expect

Key Takeaways - - CMS is expected to issue the 2026 final rate notice for Medicare Advantage (MA) and Part D plans by April 7, 2025. - The January 2025 advance notice proposed policies that would increase payments to MA...more

3/26/2025 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Advantage , Medicare Part D , Prescription Drugs , Proposed Rules , Regulatory Agenda , Risk Management , Trump Administration

Sound of Silence? What the CMS Innovation Center’s Announcement Does and Doesn’t Say

The Centers for Medicare & Medicaid Services (CMS) Innovation Center made headlines last week by announcing that it would end eight models early. The Innovation Center put out a fact sheet explaining its rationale behind...more

3/20/2025 / Centers for Medicare & Medicaid Services (CMS) , Executive Orders , Health Care Providers , Health Insurance , Healthcare Reform , Medicaid , Medicare , Regulatory Agenda , Regulatory Requirements , Trump Administration

CY 2026 MA and Part D Final Reg: Policies Under Consideration

Last week, the contract year (CY) 2026 Medicare Advantage (MA) and Part D final reg entered the clearance process at the Office of Management and Budget (OMB). As mentioned in a previous Regs & Eggs blog post, OMB’s review is...more

3/13/2025 / Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Inflation Reduction Act (IRA) , Medicaid , Medicare , Medicare Advantage , Medicare Part D , Medicare Payment Reform , Mental Health , OMB , Pharmaceutical Industry , Prescription Drugs , Prior Authorization , Proposed Rules , Technology , Utilization Review

Price Transparency: A Regulatory Priority

The Trump administration is beginning to lay out its regulatory (and deregulatory) priorities, and on February 25, 2025, the administration spotlighted one of those priorities in an executive order on price transparency....more

3/6/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Enforcement Actions , Executive Orders , Health Care Providers , Medicare , Price Transparency , Regulatory Agenda , Rulemaking Process , Trump Administration

Regs & Eggs with a Side of DOGE

In the health policy world, nothing gets folks like me more “excited” than expecting and then seeing a new healthcare regulation pop up in the Federal Register. While the content of the reg is usually what public stakeholders...more

2/27/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Government Efficiency (DOGE) , Department of Health and Human Services (HHS) , Executive Orders , Healthcare , Legislative Agendas , Medicare , Proposed Rules , Regulatory Agenda , Regulatory Reform , Rulemaking Process , Trump Administration

The Future of Medicare Advantage: Q&A with McDermott+’s Lynn Nonnemaker

A few weeks ago, Regs & Eggs provided insights into Medicare Advantage (MA), the private insurance option under Medicare, and explored both short- and long-term actions that the Trump administration could take to modify MA...more

2/13/2025 / Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare , Healthcare Reform , Insurance Industry , Medicare , Medicare Advantage , Medicare Part D , Proposed Rules , Regulatory Agenda , Trump Administration

Regs and De-Regs: What to Watch Out for Next

It is relatively quiet on the healthcare regulatory front. The Trump administration is currently filling out its leadership team within the US Department of Health and Human Services (HHS), with the confirmation process of...more

2/6/2025 / Department of Health and Human Services (HHS) , Deregulation , Executive Orders , Final Rules , Medicaid , Medicare , Proposed Rules , Regulatory Agenda , Trump Administration

Outlook for Medicare Advantage Under the Trump Administration

Medicare Advantage (MA), the private insurance option under Medicare, is one of many policy areas that will garner great attention in 2025 and beyond under the incoming Trump Administration. We recently released our 2025...more

1/16/2025 / Centers for Medicare & Medicaid Services (CMS) , Enrollment , Final Rules , Health Insurance , HRA , Legislative Agendas , Medicare , Medicare Advantage , Proposed Rules , Trump Administration

No Doc Fix or Advanced APM Bonus: What Happens Next?

Here we go again! For the second year in a row, we enter the new year without Congress enacting a doc fix or Advanced Alternative Payment Model (APM) bonus extension. While Congress did act last year on both counts (through...more

1/9/2025 / Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare Reform , Medicare , Medicare Advantage , MIPS , Physicians , Value-Based Care

Regulatory Implications of the Continuing Resolution Healthcare Package

Earlier this week, Congress released the text of a continuing resolution that includes a more-robust-than-anticipated healthcare package. While the bill’s primary purpose is to keep the government open through March 14, 2025,...more

12/19/2024 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Congressional Committees , Healthcare , Legislative Agendas , Medicaid , Medicare , Medicare Access and CHIP Reauthorization (MACRA) , MIPS , Pharmaceutical Industry , Physician Fee Schedule , Proposed Legislation , Regulatory Agenda , Regulatory Reform , Telehealth , Telemedicine

ACO REACH: What Recent Performance Results Could Mean for the Model’s Future

Decisions, decisions, decisions. The Centers for Medicare & Medicaid Services (CMS) under the Trump Administration will have its hands full making decisions about Center for Medicare and Medicaid Innovation (CMMI) models...more

12/5/2024 / ACOs , Alternative Payment Models (APM) , Biden Administration , Centers for Medicare & Medicaid Services (CMS) , CMMI , Health Care Providers , Health Insurance , Healthcare , Healthcare Reform , Medicaid , Medicare , Medicare Shared Savings Program , Trump Administration

President Trump’s FY 2021 Budget Request: A Potential Playbook for Policy Priorities

When President-elect Donald Trump is inaugurated as the 47th president of the United States on January 20, 2025, he is expected to hit the ground running. A few months into his presidency, he will likely release the fiscal...more

11/20/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Federal Budget , Food and Drug Administration (FDA) , Healthcare , Healthcare Reform , Legislative Agendas , Medicaid , Medicare , National Institute of Health (NIH) , Trump Administration

Another Trip to the Buffet: Highlights from the CY 2025 OPPS Final Reg

As mentioned last week, the Centers for Medicare & Medicaid Services (CMS) recently put out a large buffet of regs – too many to digest in one blog post. While we focused on the Calendar Year (CY) 2025 Physician Fee Schedule...more

11/14/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare , Healthcare Reform , Legislative Agendas , Medicare , New Regulations , Outpatient Prospective Payment System (OPPS) , Pharmaceutical Industry , Physician Fee Schedule , Regulatory Agenda , Telemedicine

Digesting the Huge Buffet of CMS Regs: Highlights from the CY 2025 PFS Final Reg

While we all are focused on the election results, let’s take a quick break to digest some regs and eggs. The Centers for Medicare & Medicaid Services (CMS) “spoiled” all of us in the health policy world with a huge buffet of...more

11/7/2024 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Healthcare , Healthcare Reform , Medicare , Medicare Shared Savings Program , Mental Health , MIPS , New Regulations , Outpatient Prospective Payment System (OPPS) , Physician Fee Schedule , Telehealth

CMS Releases CY 2025 Physician Fee Schedule Final Rule

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more

11/6/2024 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Hospitals , Medicare , MIPS , Outpatient Prospective Payment System (OPPS) , Physician Fee Schedule , Physicians

Jeffrey Davis

McDermott Will & Emery

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