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Health Plan Accountability Update: October 2025
The AHA May 29 submitted a letter to the Centers for Medicare & Medicaid Services responding to a request for information regarding Medicare Advantage data, urging CMS to increase oversight of the program.
CMS Issues Hospital Outpatient, Ambulatory Surgical Center Final Rule for CY 2026
The Centers for Medicare & Medicaid Services (CMS) Nov. 21 released its calendar year (CY) 2026 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule.
Skilled Nursing Facility PPS
The Centers for Medicare & Medicaid Services (CMS) July 31 issued its fiscal year (FY) 2026 final rule for the skilled nursing facility (SNF) prospective payment system (PPS).
Advisory on AHA Letter to Aetna on New Inpatient Payment Policy
The AHA today urged Aetna to rescind its recently announced “level of severity inpatient payment” policy, saying that it “could erode the transparency consumers rely on to make informed decisions about their care, undermine important regulatory protections that safeguard patients’ coverage, and jeopardize the ability of hospitals to provide highquality, accessible care to all who need it.”
CMS Issues Proposed Notice of Benefit and Payment Parameters for 2027
The Centers for Medicare & Medicaid Services (CMS) Feb. 9 released its 2027 proposed standards for the health insurance marketplaces, including the issuers and brokers who assist marketplace enrollees.
Payment Models Resources | Care Transformation Framework: Operational Infrastructure
AHA resources on the various value-based payment models, and aligned based the level of financial risk assumed by providers, and the types and scope of services included in the model.
AHA resources on value-based payment models, aligned based on the level of financial risk assumed by providers, and the types and scope of services included in the model.
CMS Proposes Updates to Conditions of Coverage for Organ Procurement Organizations
The Centers for Medicare & Medicaid Services (CMS) Jan. 28 issued a proposed rule that would update the Medicare Conditions for Coverage for Organ Procurement Organizations (OPOs).
Fact Sheet: Medicare Site-neutral Legislative Proposals Would Jeopardize Access to Care
Congress is considering several bills that would impose additional site-neutral payment reductions to services provided in hospital outpatient departments (HOPDs).
CMS Issues Proposed Rule for CY 2027 Medicare Advantage, Prescription Drug Plans
The Centers for Medicare & Medicaid Services (CMS) Nov. 28 released its proposed Policy and Technical Changes to the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program and Programs of All-Inclusive Care for the Elderly for Contract Year (CY) 2027.