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The FFY 2027 IPPS Proposed Rule (“Proposed Rule”) was released on April 10, 2026, and CMS published the associated tables on its Proposed Rule homepage. The Proposed Rule is expected to be published in the Federal Register on April 14.

The release of the Proposed Rule and the accompanying tables triggers the start of several deadlines for hospitals, including the unofficial start of the Medicare Geographic Classification Review Board (“MGCRB”) application process. Hospitals should conduct a preliminary review…
Continue Reading CMS Releases FFY 2027 IPPS Proposed Rule; Wage Index Deadlines

Indiana Medicaid implemented significant updates for applied behavior analysis (“ABA”) therapy—one of the most widely used interventions for children with autism spectrum disorder—effective April 1, 2026. The reforms include phased cuts to reimbursement for ABA therapy, updates to member eligibility and revisions to provider qualifications.

The Indiana Health Coverage Programs (“IHCP”) began covering ABA therapy in 2016. Indiana’s expenditures on ABA therapy skyrocketed since coverage began and culminated in increased scrutiny following a Wall Street Journal investigation. Governor Mike…
Continue Reading Indiana Medicaid’s ABA Therapy Overhaul: What Changed on April 1, 2026

Our previous article, In Defense of IGTs from Governmental Health Care Providers, noted that the Secretary of the Department of Health and Human Services (“HHS”) is required to “consult with the States” before issuing any regulations changing the treatment of intergovernmental transfers (“IGTs”). We received requests for further information about this requirement following the publication of that article, and the requirement gained additional attention following the Secretary’s February 27, 2026, request for information (“RFI”) seeking stakeholder feedback on…
Continue Reading The Secretary of HHS Must Consult with the States Before Issuing Regulations Changing the Treatment of IGTs

If you have been receiving long term disability (LTD) benefits, you have probably received a letter from your insurance company telling you to apply for Social Security Disability Insurance benefits, also known as SSDI. They may have offered to connect you with a service to help with this application.

You might be wondering why the insurer cares so much about whether you apply for SSDI. The short answer is that it usually saves the insurance company money. However, applying…
Continue Reading Why Long Term Disability Insurers Require You to Apply for SSDI (And How It Affects You)

The U.S. Department of Health & Human Services Office of Inspector General (“OIG”) has long been the north star for health care entities seeking guidance on creating and implementing an effective compliance program. As the author of the General Compliance Program Guidance (“GCPG”), OIG has used its years of investigative and oversight experience with health care entities to identify and recommend best practices for a wide range of entities in the U.S. health care industry.

To further OIG’s assistance…
Continue Reading Medicare Advantage Industry Segment-Specific Compliance Program Guidance Issued

The Centers for Medicare and Medicaid Services (“CMS“) issued a wide-ranging Request for Information (“RFI”) on February 26, which could reshape current program integrity efforts to prevent and detect fraud, waste and abuse in  government health care programs. CMS, under its new Comprehensive Regulations to Uncover Suspicious Healthcare (“CRUSH”) initiative, is seeking stakeholder input on potential regulatory and operational changes aimed at strengthening program integrity across Medicare, Medicaid, CHIP and the Health Insurance Marketplace (“Marketplace”). The RFI spans topics…
Continue Reading CMS Issues Sweeping Anti-Fraud RFI Under New CRUSH Initiative

As the name suggests, long-term disability benefits are supposed to last for the long term. But what does that actually mean? If you’re facing a serious injury or illness, the length of time you can count on benefits is one of the first questions you’ll want answered.
First, Consult Your Policy
Every long-term disability (LTD) policy is a bit different. The “plan documents,” or full terms of the policy, will spell out your policy’s specific rules for how long…
Continue Reading How Long Do Long-Term Disability Benefits Last?

On January 26, 2026, the Centers for Medicare & Medicaid Services (“CMS”) issued an Advance Notice of Proposed Rulemaking (“ANPRM”) seeking public input on potential policies to strengthen the domestic supply chain for personal protective equipment (“PPE”) and essential medicines used by Medicare‑participating hospitals. The initiative reflects lessons learned during the COVID‑19 public health emergency and signals a possible shift toward incentivizing or requiring greater reliance on U.S.-manufactured medical products within the Medicare program. This focus on domestic sourcing…
Continue Reading CMS Solicits Comments on Potential Approaches to Strengthen the American-Made Supply Chain

On February 2, 2026, the Centers for Medicare & Medicaid Services (“CMS”) released a new guidance letter (“February 2 Letter”) regarding state directed payments (“SDPs”) as governed by Section 71116 of Public Law 119-21 (which CMS refers to as the “Working Families Tax Cuts” or “WFTC legislation”). Per CMS, its previous September 9, 2025, guidance letter (“September 9 Letter”) has been rescinded.

The February 2 Letter largely repeats everything in the September 9 Letter. For example, the preprint-related criteria…
Continue Reading CMS Issues New Guidance Letter for State Directed Payments

On February 2, 2026, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule, effective April 3, 2026, that targets a perceived “loophole” in the current regulatory statistical test applied to State proposals for health care-related tax waivers. The test is intended to make certain that non-uniform or non-broad-based health care-related taxes, authorized under a waiver granted by CMS, are “generally redistributive.” CMS claims the loophole impermissibly allowed some health care-related taxes to be imposed at…
Continue Reading CMS Issues Health Care-Related Tax Final Rule

On January 30, 2026, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule that would substantially revise portions of the Conditions for Coverage for Organ Procurement Organizations (“OPOs”) (the “Proposed Rule”). According to CMS, the Proposed Rule is characterized as building on changes in the 2020 OPO Conditions for Coverage rule aimed at increasing accountability, clarifying and strengthening re-certification standards and reinforcing public trust in organ procurement and allocation practices, and in doing so is intended…
Continue Reading Proposed OPO Rule Signals Broad Operational and Compliance Changes Across the Donation and Transplantation System

Congress’s fiscal year 2026 health care appropriations bill introduces a significant new statutory condition of Medicare payment for off-campus hospital outpatient departments. If enacted, effective January 1, 2028, Medicare payment would be prohibited for items and services furnished by an off-campus hospital outpatient department unless two conditions are met: (1) the department has a National Provider Identifier (“NPI”) that is separate from the hospital’s main NPI; and (2) the hospital has submitted the required provider-based status attestation.

Although framed…
Continue Reading Legislative Update: Congress Set to Resurrect Separate NPI and Attestation Requirements for Off-Campus Hospital Outpatient Departments

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On January 21, 2026, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released its Semiannual Report to Congress for the six-month period ending September 30, 2025 (“Report”). OIG’s enforcement actions during this period resulted in “the largest health care fraud takedown in the Department of Justice history, involving more than $14.6 billion in intended losses,” and improved the return on investment in OIG to $12.70 in expected recoveries and receivables (money agreed to be…
Continue Reading OIG Recounts Historic Recovery Numbers in Its Latest Semiannual Report to Congress

Piggy bank with stethoscope isolated on light blue background with copy space. Health care financial checkup or saving for medical insurance costs concept.

Some of the advocacy groups and think tanks that lobbied for the Medicaid provider tax restrictions in last year’s H.R. 1 are now renewing their criticisms of the states’ use of “intergovernmental transfers” (“IGTs”) from governmental health care providers to fund the non-federal share of Medicaid payments to those same providers.[1] The critics’ goal appears to be twofold: first, to shift Medicaid costs away from the federal government despite the federal government’s shared financial responsibility with the states…
Continue Reading In Defense of Intergovernmental Transfers from Governmental Health Care Providers

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The Centers for Medicare & Medicaid Services (“CMS”) continues to scrutinize beneficiary transparency, medical necessity and data‑driven oversight of hospital billing and utilization. This scrutiny means continued compliance risk for hospitals. Two long‑standing compliance tools remain especially relevant for hospital leadership: the Medicare Outpatient Observation Notice (“MOON”) and the Program for Evaluating Payment Patterns Electronic Report (“PEPPER”). Recent CMS communications reaffirm expectations related to proper MOON delivery and highlight PEPPER as an active monitoring mechanism hospitals should be using…
Continue Reading Medicare Outpatient Observation Notice and PEPPER Reports: Key Compliance Considerations

On December 29, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced the first round of awards under the Rural Health Transformation Program (“RHTP”), a $50 billion, five-year initiative intended to strengthen and modernize health care delivery in rural communities nationwide. All 50 states will receive funding beginning in Federal Fiscal Year (“FFY”) 2026, with first-year awards averaging $200 million per state.

At the same time, CMS formally established the Office of Rural Health Transformation within the Center…
Continue Reading CMS Announces $50 Billion Rural Health Transformation Program Awards to All 50 States