Stakeholders in the Medicare value-based care world have without a doubt heard of the Merit-based Incentive Payment System (MIPS), MIPS Value Pathways (MVPs), and alternative payment models (APMs). While all these initiatives...more
8/13/2025
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Medicare Part B ,
MIPS ,
Physician Fee Schedule ,
Physicians ,
Proposed Rules ,
Value-Based Care
Recently, the Centers for Medicare & Medicaid Services (CMS) issued all the fiscal year (FY) 2026 Medicare final regulations for different facility types: hospice facilities, inpatient psychiatric facilities, inpatient...more
It’s been more than two weeks since the release of the CY 2026 Medicare Physician Fee Schedule (PFS) proposed rule. We’ve had a chance to digest our initial helping and now we’re ready for seconds. We thought we would see...more
7/31/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Digital Health ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Insurance Industry ,
Medical Devices ,
Medicare ,
Medicare Fraud ,
Mental Health ,
Technology ,
Telehealth
Last week, the Centers for Medicare & Medicaid Services (CMS) issued two major regs: the calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) proposed rule and the CY 2026 Outpatient Prospective Payment System (OPPS)...more
7/24/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
Legislative Agendas ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Payment Systems ,
Physicians ,
Proposed Rules ,
Regulatory Agenda ,
Regulatory Requirements ,
Trump Administration
On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1834-P],...more
7/18/2025
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Financial Services Industry ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Payment Systems ,
Proposed Rules ,
Regulatory Requirements ,
Reporting Requirements
On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-13271]...more
7/17/2025
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Healthcare Reform ,
Insurance Industry ,
Medicare ,
Medicare Part B ,
Medicare Shared Savings Program ,
New Regulations ,
Physician Fee Schedule ,
Proposed Rules ,
Regulatory Agenda ,
Technology ,
Telehealth
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) proposed reg. Stakeholders have highly anticipated the release of this reg, as it...more
7/17/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Insurance Industry ,
Medicare ,
MIPS ,
Payment Systems ,
Physician Fee Schedule ,
Physicians ,
Proposed Regulation ,
Proposed Rules ,
Regulatory Requirements ,
Technology ,
Telehealth
Many healthcare programs are extended for specific time periods, as short as one or two years or as long as 10, and are usually attached to a larger piece of must-pass legislation. Additionally, while traditional...more
The last week of June was a busy one when it comes to news about prior authorization – a major tool used by health plans and the federal government to manage healthcare utilization. The week started with a commitment from...more
7/10/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Fee-for-Service ,
Fraud ,
Government Agencies ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Medicare Advantage ,
Prior Authorization ,
Regulatory Reform ,
Waste
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
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
6/11/2025
/ Affordable Care Act ,
Budgets ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Federal Budget ,
Fraud Abuse and Waste ,
FTEs ,
Healthcare ,
Healthcare Reform ,
MACs ,
Medicaid ,
Medicare ,
Medicare Part C ,
Medicare Part D ,
Payment Systems ,
Section 340B ,
Telehealth ,
Telemedicine ,
Value-Based Care
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
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
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
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
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
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
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 -
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
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
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
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
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
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
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