Thursday, May 21, 2026

A House subcommittee hearing today is examining issues with the Medicare Physician Fee Schedule and reforms under MACRA. The AHA has already submitted recommendations calling for changes to stabilize payments. This signals ongoing congressional focus on the annual conversion factor cuts and value-based payment design. Monitor the hearing record for specific legislative proposals and any potential movement on a bipartisan payment fix before the 2027 rulemaking cycle.

Democratic senators, led by Patty Murray, are using the Congressional Review Act to force a vote to end CMS's WISeR AI prior authorization pilot. The resolution argues the program is overruling doctors and delaying care for seniors. If passed, it would rescind the rule and block CMS from issuing a substantially similar one. The move reflects deepening political opposition to automated denials. Track the resolution's progress; a vote could occur this summer.

CMS has released a proposed rule on Medicaid supplemental payments. Modern Healthcare reports the rule would restrict state-directed payments, a key funding mechanism for hospitals, particularly those serving large Medicaid populations. This follows heightened scrutiny from the agency on how states finance their share of Medicaid. The proposal, if finalized, could pressure hospital margins in states reliant on these payments. The rule is now open for public comment.

Florida hospitals secured an $8 billion increase in Medicaid supplemental payments, approved by CMS just before the Biden administration's expected caps on such state-directed payments could take effect. The funds, part of Florida's Medicaid waiver, will flow to hospitals through 2028. This move highlights the ongoing tension between states seeking to draw down federal Medicaid dollars for hospitals and federal efforts to rein in spending. For practices, it signals that major Medicaid funding decisions are happening at the state waiver level, with significant financial consequences for hospital partners and the local safety net.