What is the One Big Beautiful Bill Act (OBBBA) and how does it impact Medicaid?

OBBBA is a reconciliation bill that includes substantial Medicaid spending cuts, work requirements, and provider payment caps. It may result in over 11 million individuals losing healthcare coverage, with particular risk to rural hospitals due to limits on provider taxes and state-directed payments.

How does the FY 2026 budget proposal affect CMS and healthcare oversight?

The proposal reduces CMS’s budget by 16% and cuts Medicare Administrative Contractor funding by 30%, shifting responsibilities like 340B oversight and QIO reviews to MACs, potentially reducing provider support and increasing compliance pressure.

What are the implications of the expanded Medicare Advantage RADV audits?

CMS will audit 2018–2024 plan data using AI and expand its team of medical coders, increasing the likelihood of clawbacks. Providers should review documentation practices and indemnification clauses in payer contracts.

What recent guidance has CMS issued on price transparency and gender dysphoria treatment?

CMS requires hospitals to report actual prices, not estimates, and prohibits placeholders like '999.' New gender dysphoria guidance includes data collection from hospitals and state Medicaid agencies, with a focus on current research and clinical protocols.

How does the Medicare Trustee Report project insolvency?

The 2025 report projects that the Medicare Hospital Insurance Trust Fund will be insolvent by 2033 due to higher-than-expected spending on inpatient and hospice care, with reserves depleted by 2027.

New Webinar: “Washington Updates: One Big Beautiful Bill, Lots of Proposed Rules”

Wednesday, July 16, 2025

11:00 am – 12:00 pm E.T.

Duration: 60 Minutes

Webinars

Series

Healthcare Regulatory Roundup

Twice each month, PYA experts discuss the latest industry developments as part of our popular Healthcare Regulatory Roundup (HCRR) webinar series. In addition to straightforward explanations of those developments and actionable guidance, attendees will be offered the chance to earn continuing professional education units in selected sessions.

Washington Updates

The One Big Beautiful Bill Act (OBBBA) is now law, and healthcare providers must quickly assess its implications. In this session, PYA’s Martie Ross and Kathy Reep will examine OBBBA’s sweeping changes to Medicare, Medicaid, and the ACA Marketplace.

Martie and Kathy will also address new proposed rules from the Centers for Medicare & Medicaid Services (CMS), including the 2026 hospital outpatient, home health, and end-stage renal disease payment rules.