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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 – June 18, 2025

THIS WEEK’S DOSE - - Senate Finance Committee Releases Reconciliation Text. The language is subject to change as negotiations continue and the Byrd rule process plays out. - CMS Releases MA Risk Adjustment Audit Methodology…more

Affordable Care Act, Budget Reconciliation, Centers for Medicare & Medicaid Services (CMS), Federal Funding, Government Agencies

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Jeffrey Davis

Health Information Technology Policy Under the Trump Administration

Patient engagement. Information blocking. Interoperability. These buzz words are flying around the health information technology (HIT) world as the Trump administration starts to make its mark on the HIT policy landscape. While…more

Centers for Medicare & Medicaid Services (CMS), Data Privacy, Department of Health and Human Services (HHS), Digital Health, Health Care Providers

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Leigh Feldman

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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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

Inpatient Prospective Payment System (IPPS) Data Dashboard

Updated to include Medicare claims data thru Q4 2024. 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…more

Centers for Medicare & Medicaid Services (CMS), Healthcare, Healthcare Costs, Healthcare Facilities, Healthcare Reform

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Julia Grabo

McDermott+ Check-Up: June 13, 2025

THIS WEEK’S DOSE - - Reconciliation Moves Forward. Senate committees continue to release their reconciliation provisions. - NIH Director Testifies on FY 2026 Budget. National Institutes of Health (NIH) Director Bhattacharya…more

Biden Administration, Budget Reconciliation, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Executive Orders

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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: June 16, 2025

The House is out this week for the Juneteenth holiday, but the Senate will be in town through Wednesday. We expect these three days to be significant because the Senate Finance Committee has announced that it intends to release…more

Affordable Care Act, Budget Reconciliation, Congressional Committees, Healthcare, Healthcare Reform

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Rachel Hollander

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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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

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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Lauren Knizner

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

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

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Marie Knoll

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 System…more

Centers for Medicare & Medicaid Services (CMS), Healthcare, Healthcare Facilities, Hospitals, Medicare

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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 – June 18, 2025

THIS WEEK’S DOSE - - Senate Finance Committee Releases Reconciliation Text. The language is subject to change as negotiations continue and the Byrd rule process plays out. - CMS Releases MA Risk Adjustment Audit Methodology…more

Affordable Care Act, Budget Reconciliation, Centers for Medicare & Medicaid Services (CMS), Federal Funding, Government Agencies

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Simeon Niles

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 System…more

Centers for Medicare & Medicaid Services (CMS), Healthcare, Healthcare Facilities, Hospitals, Medicare

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Lynn Nonnemaker

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 new…more

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), Drug Pricing, Executive Orders, Food and Drug Administration (FDA)

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Kristen O'Brien

McDermott+ Check-Up – June 18, 2025

THIS WEEK’S DOSE - - Senate Finance Committee Releases Reconciliation Text. The language is subject to change as negotiations continue and the Byrd rule process plays out. - CMS Releases MA Risk Adjustment Audit Methodology…more

Affordable Care Act, Budget Reconciliation, Centers for Medicare & Medicaid Services (CMS), Federal Funding, Government Agencies

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Parashar Patel

Inpatient Prospective Payment System (IPPS) Data Dashboard

Updated to include Medicare claims data thru Q4 2024. 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…more

Centers for Medicare & Medicaid Services (CMS), Healthcare, Healthcare Costs, Healthcare Facilities, Healthcare Reform

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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

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 plans…more

Centers for Medicare & Medicaid Services (CMS), Final Rules, Medicare, Medicare Advantage, Medicare Part D

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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 – June 18, 2025

THIS WEEK’S DOSE - - Senate Finance Committee Releases Reconciliation Text. The language is subject to change as negotiations continue and the Byrd rule process plays out. - CMS Releases MA Risk Adjustment Audit Methodology…more

Affordable Care Act, Budget Reconciliation, Centers for Medicare & Medicaid Services (CMS), Federal Funding, Government Agencies

See all updates »

Devin Stone

Inpatient Prospective Payment System (IPPS) Data Dashboard

Updated to include Medicare claims data thru Q4 2024. 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…more

Centers for Medicare & Medicaid Services (CMS), Healthcare, Healthcare Costs, Healthcare Facilities, 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: June 16, 2025

The House is out this week for the Juneteenth holiday, but the Senate will be in town through Wednesday. We expect these three days to be significant because the Senate Finance Committee has announced that it intends to release…more

Affordable Care Act, Budget Reconciliation, Congressional Committees, Healthcare, Healthcare Reform

See all updates »

Rodney Whitlock Ph.D.

Healthcare Preview for the Week of: June 16, 2025

The House is out this week for the Juneteenth holiday, but the Senate will be in town through Wednesday. We expect these three days to be significant because the Senate Finance Committee has announced that it intends to release…more

Affordable Care Act, Budget Reconciliation, Congressional Committees, Healthcare, Healthcare Reform

See all updates »

Eric Zimmerman

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 System…more

Centers for Medicare & Medicaid Services (CMS), Healthcare, Healthcare Facilities, Hospitals, Medicare

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