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Emily Jane Cook

Policy Update - CMS Finalizes Remedy for 340B-Acquired Drugs Purchased in CYs 2018–2022

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) finalized the rule Medicare Program; Hospital Outpatient Prospective Payment System: Remedy for the Calendar Years 2018–2022 to addresses how the agency… more

Centers for Medicare & Medicaid Services (CMS), Drug Pricing, Final Rules, Healthcare, Healthcare Facilities

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Emily Curran

Policy Update - CMS Releases CY 2024 Physician Fee Schedule Final Rule

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B… more

Centers for Medicare & Medicaid Services (CMS), Final Rules, Health Care Providers, Medicare, Medicare Part B

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Debra Curtis

McDermott+ Check-Up – August 1, 2025

Senate HELP Committee advances legislation, examines healthcare affordability. The legislation would reauthorize expiring programs, including the Over-the-Counter Monograph Drug User Fee Program. Senate Appropriations… more

Biden Administration, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Drug Pricing, Healthcare

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Jeffrey Davis

Back for seconds: digital health policies in the CY 2026 PFS proposed rule

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 this… more

Centers for Medicare & Medicaid Services (CMS), Digital Health, Health Care Providers, Health Insurance, Healthcare

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Leigh Feldman

Healthcare Extenders Tracker (July 2025 Update)

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 authorizations… more

Federal Funding, Government Agencies, Health Care Providers, Healthcare, Healthcare Reform

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Gregory Fosheim

CMS Requests Hospitals Submit Gender-Affirming Care Data- (UPDATED)

On May 28, 2025, the Centers for Medicare & Medicaid Services (CMS) sent a letter to “select hospitals” that provide gender-affirming care services, requesting information about how those hospitals adhere to quality standards… more

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Enforcement Actions, Gender Identity, Government Agencies

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Jamie Gelfman

Breaking Down the New No Surprises Act FAQs Post-TMA III (June 2025 Update)

UPDATE: On May 30, 2025, the Fifth Circuit granted the TMA III plaintiffs’ petition for rehearing en banc, which was previously filed on December 16, 2024. Of note, the Fifth Circuit’s mandate has not yet been issued, so as a… more

Appeals, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Dispute Resolution, Health Insurance

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Deborah Godes

Site neutrality is on the menu in the CY 2026 Medicare Outpatient Prospective Payment System proposed rule

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

Centers for Medicare & Medicaid Services (CMS), Healthcare, Healthcare Reform, Hospitals, Legislative Agendas

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Olivia Gomez

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

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Julia Grabo

McDermott+ Check-Up – August 1, 2025

Senate HELP Committee advances legislation, examines healthcare affordability. The legislation would reauthorize expiring programs, including the Over-the-Counter Monograph Drug User Fee Program. Senate Appropriations… more

Biden Administration, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Drug Pricing, Healthcare

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Abygail Hoey

Breaking Down the New No Surprises Act FAQs Post-TMA III (June 2025 Update)

UPDATE: On May 30, 2025, the Fifth Circuit granted the TMA III plaintiffs’ petition for rehearing en banc, which was previously filed on December 16, 2024. Of note, the Fifth Circuit’s mandate has not yet been issued, so as a… more

Appeals, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Dispute Resolution, Health Insurance

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Kayla Holgash

Healthcare Preview for the Week of: July 28, 2025

Senate Steers Toward Summer Break - With the House already on August recess, the Senate will consider several of President Trump’s nominees, including Gustav Chiarello III to be an assistant secretary of the US Department of… more

Department of Health and Human Services (HHS), Government Agencies, Healthcare, Healthcare Reform, Legislative Agendas

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Rachel Hollander

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

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Travis Jackson

CMS Requests Hospitals Submit Gender-Affirming Care Data- (UPDATED)

On May 28, 2025, the Centers for Medicare & Medicaid Services (CMS) sent a letter to “select hospitals” that provide gender-affirming care services, requesting information about how those hospitals adhere to quality standards… more

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Enforcement Actions, Gender Identity, Government Agencies

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Josh Jorgensen

Health-Related Provisions in the House Reconciliation Package (June 2025 Update)

UPDATE: On June 4, 2025, the Congressional Budget Office (CBO) released updated cost estimates of H.R. 1, the One Big Beautiful Bill Act. We have updated our summary of the bill’s health provisions to reflect these new CBO… more

Centers for Medicare & Medicaid Services (CMS), Federal Budget, Healthcare, Healthcare Reform, Medicaid

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Yamini Kalidindi

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 calendar… more

Centers for Medicare & Medicaid Services (CMS), Healthcare Reform, Medicaid, Medicare, Medicare Access and CHIP Reauthorization (MACRA)

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Amy Kelbick

Healthcare Extenders Tracker (July 2025 Update)

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 authorizations… more

Federal Funding, Government Agencies, Health Care Providers, Healthcare, Healthcare Reform

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Lauren Knizner

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

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Marie Knoll

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

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Maria Kugel

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

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Anthony Livshen

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

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Drew Elizabeth McCormick

Breaking Down the New No Surprises Act FAQs Post-TMA III (June 2025 Update)

UPDATE: On May 30, 2025, the Fifth Circuit granted the TMA III plaintiffs’ petition for rehearing en banc, which was previously filed on December 16, 2024. Of note, the Fifth Circuit’s mandate has not yet been issued, so as a… more

Appeals, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Dispute Resolution, Health Insurance

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Maddie News

McDermott+ Check-Up – August 1, 2025

Senate HELP Committee advances legislation, examines healthcare affordability. The legislation would reauthorize expiring programs, including the Over-the-Counter Monograph Drug User Fee Program. Senate Appropriations… more

Biden Administration, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Drug Pricing, Healthcare

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Simeon Niles

Three key takeaways from the CMS Innovation Center’s new WISeR Model

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 major… more

Centers for Medicare & Medicaid Services (CMS), Fee-for-Service, Fraud, Government Agencies, Health Care Providers

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Lynn Nonnemaker

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

See all updates »

Kristen O'Brien

McDermott+ Check-Up – August 1, 2025

Senate HELP Committee advances legislation, examines healthcare affordability. The legislation would reauthorize expiring programs, including the Over-the-Counter Monograph Drug User Fee Program. Senate Appropriations… more

Biden Administration, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Drug Pricing, Healthcare

See all updates »

Parashar Patel

Inpatient Prospective Payment System (IPPS) Data Dashboard (UPDATED)

What is the cost of a knee implant in the inpatient setting? How much does Medicare pay for different types of cardiac valve procedures? How have Medicare inpatient volumes changed over time for inpatient hip and femur… more

Centers for Medicare & Medicaid Services (CMS), Health Care Providers, Healthcare Costs, Healthcare Facilities, Hospitals

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Paul Radensky, MD

CMS Releases Final Procedural Notice on Transitional Coverage for Emerging Technology (TCET)

The Centers for Medicare & Medicaid Services (CMS) issued the final procedural notice on Transitional Coverage for Emerging Technologies (TCET), effective as of August 12, 2024. TCET is a new pathway that uses existing national… more

Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), Insurance Industry, MACs, Manufacturers

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Priya Rathakrishnan

M+ Check-Up: August 2, 2024

Senate HELP Committee Marks Up Public Health Program Reauthorizations. The bills would reauthorize several programs related to older adults, individuals with developmental disabilities and individuals with traumatic brain… more

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Final Rules, Healthcare, Healthcare Reform

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Michael Ryan

CMS Releases Procedural Notice with Comment Period on Transitional Coverage for Emerging Technology

On June 22, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a procedural notice with comment period on Transitional Coverage for Emerging Technologies (TCET), a new pathway that uses existing national coverage… more

Centers for Medicare & Medicaid Services (CMS), Emerging Technologies, Food and Drug Administration (FDA), Medical Devices, Medicare

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Christopher Salmen

REGS & TURKEY LEGS: The Regs We’re Thankful For

It’s Thanksgiving week, so instead of eating eggs with your regs, you should sit back, relax and reflect on the regs you are thankful for as you eat your turkey legs (or whatever you enjoy on Thanksgiving). Many of the policies… more

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Digital Health, Final Rules, Healthcare

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Tessa Smith

Site Neutral Payment: Top 10 Services Likely to Be Impacted by Proposed Legislation

On April 26, 2023, the House Energy and Commerce Committee Health Subcommittee held a legislative hearing on 17 healthcare bills, including one that would direct the Centers for Medicare & Medicaid Services (CMS) to implement… more

Centers for Medicare & Medicaid Services (CMS), Fee-for-Service, Medicare, MedPAC, Proposed Legislation

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Rachel Stauffer

Back for seconds: digital health policies in the CY 2026 PFS proposed rule

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 this… more

Centers for Medicare & Medicaid Services (CMS), Digital Health, Health Care Providers, Health Insurance, Healthcare

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Brian Stimson

Special Report - No Surprises Act Update: The TMA III Decision - August 2023

The Texas Medical Association and additional plaintiffs have brought four Administrative Procedure Act (APA) challenges to the rules and guidance implementing the No Surprises Act (NSA) (termed TMA I, II, III and IV). The… more

Administrative Procedure Act, Department of Health and Human Services (HHS), Department of Justice (DOJ), Department of Labor (DOL), Disclosure Requirements

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Erica Stocker

McDermott+ Check-Up – August 1, 2025

Senate HELP Committee advances legislation, examines healthcare affordability. The legislation would reauthorize expiring programs, including the Over-the-Counter Monograph Drug User Fee Program. Senate Appropriations… more

Biden Administration, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Drug Pricing, Healthcare

See all updates »

Devin Stone

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

See all updates »

Jeffrey Stone

Site Neutral Payment: Top 10 Services Likely to Be Impacted by Proposed Legislation

On April 26, 2023, the House Energy and Commerce Committee Health Subcommittee held a legislative hearing on 17 healthcare bills, including one that would direct the Centers for Medicare & Medicaid Services (CMS) to implement… more

Centers for Medicare & Medicaid Services (CMS), Fee-for-Service, Medicare, MedPAC, Proposed Legislation

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Dale Van Demark

Policy Update - New York 1115 Waiver Amendment Timeline for Medicaid Hospital Global Budget Initiative

A key element of the Medicaid Redesign Team 1115 Waiver amendment is the Medicaid Hospital Global Budget Initiative (GBI), a reimbursement model tied very closely to the States Advancing All-Payer Health Equity Approaches and… more

1115 Waivers, Centers for Medicare & Medicaid Services (CMS), Deadlines, Health Care Providers, Healthcare

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Katie Waldo

Healthcare Preview for the Week of: July 28, 2025

Senate Steers Toward Summer Break - With the House already on August recess, the Senate will consider several of President Trump’s nominees, including Gustav Chiarello III to be an assistant secretary of the US Department of… more

Department of Health and Human Services (HHS), Government Agencies, Healthcare, Healthcare Reform, Legislative Agendas

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Rodney Whitlock Ph.D.

Healthcare Preview for the Week of: July 28, 2025

Senate Steers Toward Summer Break - With the House already on August recess, the Senate will consider several of President Trump’s nominees, including Gustav Chiarello III to be an assistant secretary of the US Department of… more

Department of Health and Human Services (HHS), Government Agencies, Healthcare, Healthcare Reform, Legislative Agendas

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Eric Zimmerman

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

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], which… more

Ambulatory Surgery Centers, Centers for Medicare & Medicaid Services (CMS), Financial Services Industry, Healthcare, Healthcare Reform

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