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Monday, Apr 14 2025

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CMS Proposes Hospital Pay Hike For 2026

Under the proposed rule for fiscal 2026, Medicare reimbursements for inpatient hospital care would rise 2.4%. Reimbursements for long-term care hospitals would rise 2.6%, and nursing home reimbursements would rise 2.8%. Other Medicare and Medicaid news is on pricey bandages, provider taxes, and more.

Medicare reimbursements for inpatient hospital care would increase 2.4% in fiscal 2026 under a proposed rule the Centers for Medicare and Medicaid Services published Friday. Long-term care hospitals would get a 2.6% pay hike under the same draft regulation. A separate rule issued Friday calls for a 2.4% boost to inpatient psychiatric facility rates next fiscal year, which begins Oct. 1. (Early, 4/11)

Skilled nursing homes would receive a 2.8% payment bump in fiscal 2026 under a proposed rule the Centers for Medicare and Medicaid Services announced late Friday. MS said the proposed rate increase includes a market basket update of 3%, a 0.6% market basket forecast error adjustment and a cut of 0.8% due to a productivity adjustment. The proposed pay hike is far below the 4.2% pay increase CMS gave nursing homes in fiscal 2025. (Eastabrook, 4/11)

In other Medicare news 鈥

Last year, Medicare Advantage (MA) plans spent $38 billion on services traditional Medicare doesn't pay for, such as gym memberships, meals, transportation, and dental care. But a report presented to the Medicare Payment Advisory Commission (MedPAC) Thursday lamented the agency's inability to evaluate the value of those services, to what extent beneficiaries actually used them, and with which companies the plans contract to provide them. (Clark, 4/11)

The Trump administration announced Friday it would delay the implementation of a Biden-era rule meant to restrict coverage of unproven and costly bandages known as skin substitutes. The policy will be delayed until 2026, allowing companies to continue setting high prices for new products, taking advantage of a loophole in Medicare rules. The companies sell those bandages at a discount to doctors, who then charge Medicare the full sticker price and pocket the difference, The New York Times reported on Thursday. (Kliff and Thomas, 4/11)

In Medicaid developments 鈥

The Centers for Medicare and Medicaid Services is cutting off funding for initiatives designed to address health-related social needs for Medicaid enrollees, the agency notified states in a letter Thursday. So-called designated state health programs and designated state investment programs currently in operation under 1115 waivers may continue, but CMS will not extend them nor approve new applications, Center for Medicaid Director Drew Snyder wrote in a letter to state officials. (Early, 4/11)

An obscure set of state taxes on hospitals and other health providers is in the crosshairs of congressional budget cutters because the levies can lead to higher federal spending on Medicaid. Known as provider taxes because states impose them on hospitals, nursing homes and other facilities that provide healthcare, the taxes boost a state鈥檚 budget for funding Medicaid. That in turn attracts more matching federal dollars to fund the program鈥攎oney that is ultimately directed back to the hospitals and clinics. (Walker, 4/14)

House Speaker Mike Johnson (R-La.) said Sunday that Republicans would protect entitlement programs as they press ahead with deep cuts to federal spending, but he added the government must 鈥渆liminate people on Medicaid鈥 who are not 鈥渆ligible to be there.鈥 鈥淭he president has made absolutely clear many times, as we have as well, that we鈥檙e going to protect Medicare, Social Security, Medicaid, for people who are legally beneficiaries of those programs,鈥 Johnson told Maria Bartiromo on Fox News鈥檚 鈥淪unday Morning Futures.鈥 (Suter, 4/13)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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