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| Little progress on ACA tax credit extension as Congress returns from Thanksgiving
With just two legislative weeks left on the 2025 calendar, Congress returned from Thanksgiving with no clear path forward on how to address the looming expiration of the ACA’s enhanced premium tax credits. A White House plan to extend the subsidies for two years with new income limits and other changes was shelved last week amid GOP opposition, although Speaker Mike Johnson said this week House Republicans are still planning to unveil a healthcare plan in the coming days and vote on it by the end of the month. Meanwhile, Senate Democrats are planning to hold a vote on a clean three-year extension of ACA tax credits next week. Moderate rank-and-file members in both the House and Senate have been exchanging proposals for a bipartisan compromise solution to extend the subsidies with an income cap and other guardrails, but it’s not likely any of those proposals will gain enough traction in time to prevent a projected 114% jump in ACA marketplace premiums next year. |
| CMS releases 2026 Hospital OPPS and Ambulatory Surgical Center final rule
On Nov. 21, the Centers for Medicare & Medicaid Services (CMS) released the 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. Relevant updates include:
- Hospitals meeting outpatient quality and electronic health record reporting requirements will receive a 2.6% payment increase in 2026. ASCs will also receive a 2.6% update.
- The OPPS and ASC payment systems will be revised along with updates to the Hospital Outpatient Quality Reporting Program, the ASC Quality Reporting (ASCQR) Program, and other quality in Within the ASCQR Program, CMS chose not to finalize the adoption of the “Patient Understanding of Key Information Related to Recovery After a Facility-Based Outpatient Procedure or Surgery” Patient-Reported Outcome-Based Performance Measure at this time.
- CMS is finalizing its proposal to eliminate the Medicare Inpatient-Only List over three years, beginning with the removal of nearly all musculoskeletal codes on Jan. 1, 2026. CMS is also finalizing revisions to the ASC Covered Procedures List, including changes to the general standard criteria and the elimination of five exclusion criteria, which will now be recast as nonbinding physician considerations for patient safety.
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CMS releases contract year 2027 MA and Part D proposed rule
On Nov. 25, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to update the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part D), and the Medicare Cost Plan Program. The proposal includes revisions to regulations governing Part C, Part D, and cost plans, addressing areas such as Star Ratings, marketing and communications, drug coverage, enrollment processes, special needs plans, and other operational policies. The proposed rule also includes several requests for information. CMS is specifically requesting feedback on approaches to streamline regulations and reduce the administrative burden for Medicare program participants. |
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