Policy and Regulation

Lawmakers Seeking Stakeholder Input to Improve 340B Drug Pricing Program

June 20, 2023 - A group of bipartisan lawmakers is seeking feedback from stakeholders on how Congress can improve the 340B Drug Pricing Program and ensure transparency and stability within the program. US Sens. John Thune (R-SD), Debbie Stabenow (D-MI), Shelley Moore Capito (R-WV), Tammy Baldwin (D-WI), Jerry Moran (R-KS), and Ben Cardin (D-MD) are members of the...


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AMA Opposes Non-Compete Agreements for Hospital-Employed Physicians

by Victoria Bailey

The American Medical Association’s (AMA) House of Delegates has voted to oppose non-compete agreements for physicians employed by hospitals or staffing companies. Non-compete agreements prohibit...

AHA Condemns FTC’s Unconstitutional Antitrust Enforcement Practices

by Victoria Bailey

The American Hospital Association (AHA) is urging an appeals court to prevent the Federal Trade Commission (FTC) from breaking up a biotechnology acquisition, stating that the agency’s antitrust...

Biden’s FY24 Budget Aims to Extend Medicare Trust Fund Solvency

by Victoria Bailey

President Biden has announced plans to extend the solvency of the Medicare Trust Fund by at least 25 years in the fiscal year (FY) 2024 budget. The budget includes proposals to stretch the solvency of...

AMA Urges CMS to Finalize Medicare Advantage Prior Authorization Reforms

by Victoria Bailey

The American Medical Association (AMA) and 118 other medical organizations have urged CMS to finalize its proposed prior authorization reforms for the Medicare Advantage program. In a letter to CMS...

Bipartisan Bill Calls for Extended Value-Based Payment Incentives

by Victoria Bailey

US Senators John Barrasso (R-WY) and Sheldon Whitehouse (D-RI) have introduced a bipartisan bill that would extend value-based payment incentives for healthcare providers participating in...

More Hospitals Complying With Price Transparency Rule Requirements

by Victoria Bailey

Almost two-thirds of hospitals are complying with hospital price transparency rule requirements and have published machine-readable files with negotiated rates or cash rates, according to Turquoise...

FAH Urges Congress to Pass Legislation to Limit Medicare Payment Cuts

by Victoria Bailey

As the 117th Congress nears the end of its session, the Federation of American Hospitals (FAH) has called upon congressional leaders to pass legislation that will reduce financial challenges for...

Urethral Suspension Use Not Impacted by Medicare Payment Policy Changes

by Victoria Bailey

Adjunct urethral suspension use with laparoscopic radical prostatectomy did not change after CMS implemented Medicare payment policy changes that decreased reimbursement for prostatectomies, according...

CMS Suspends Certificates of Medical Necessity, DME Forms for 2023

by Victoria Bailey

CMS has announced that it will no longer require healthcare stakeholders to submit Certificates of Medical Necessity (CMNs) or Durable Medical Equipment (DME) Information Forms (DIFs) for service...

Cancer Centers Fail to Comply with Hospital Price Transparency Rule

by Victoria Bailey

Less than one-third of hospitals with National Cancer Institute (NCI) cancer center designation were fully compliant with the CMS hospital price transparency rule, according to research published in...

Will Medicare Physician Fee Schedule Changes Drive Value-Based Care?

by Victoria Bailey

The proposed changes in the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2023 may offer incentives for provider groups to consider alternative payment models. Still, the policies will likely require more apparent benefits...

CMS Releases FY23 Final Rules for Hospice Providers, IPFs, IRFs

by Victoria Bailey

CMS has released final rules solidifying Medicare reimbursement rates for hospice providers, inpatient psychiatric facilities (IPFs), and inpatient rehabilitation facilities (IRFs) for fiscal year...

House Reps Ask HHS to Clarify Critical Access Hospital Payment Rule

by Victoria Bailey

A bipartisan group of 25 House members has asked HHS to clarify its plans regarding the enforcement of Medicare’s 96-hour payment rule for critical access hospitals (CAHs) following the end of...

Hospital Price Transparency Higher in Less Competitive Markets

by Victoria Bailey

Hospitals with greater market shares and those in less competitive regions had higher compliance with the payer-specific negotiated prices requirement of the hospital price transparency rule, according...

CMS Releases FAQ for No Surprises Act Implementation, Requirements

by Victoria Bailey

CMS has released Frequently Asked Questions (FAQs) on the No Surprises Act implementation, providing details about balance billing and notice and consent prohibitions. The No Surprises Act prohibits...

AHA Supports Bill to Increase Oversight of Travel Nursing Agencies

by Victoria Bailey

The American Hospital Association (AHA) has expressed support for a new bill that would direct the Government Accountability Office (GAO) to increase surveillance of travel nursing agencies and their...

Georgia Hospitals Fined for Hospital Price Transparency Violations

by Victoria Bailey

Two Georgia hospitals have received fines from CMS for violating the hospital price transparency rule. Following unanswered warning notices, CMS sent notices of imposition of a civil monetary penalty...

Advocate Aurora Health Faces Allegations of Anticompetitive Practices

by Victoria Bailey

A self-insured pharmacy has filed a class action lawsuit against Advocate Aurora Health, alleging that the health system engaged in anticompetitive practices that raised healthcare prices for Wisconsin...

CO Supreme Court: Hospital Cannot Enforce $229K Surprise Bill

by Victoria Bailey

The Colorado Supreme Court has ruled that a woman is not liable for her $229,000 surprise bill from a Centura Health hospital, as the hospital did not disclose the amount to her before the...