Medicaid Managed Care State Directed Payments Rule

Our trilogy closes where a lot of state Medicaid financing quietly lives: state directed payments. CMS wants to swap the current commercial-rate benchmark for a Medicare-based one — and extend it further than the law technically requires. We close out the series with the $500-billion question of who absorbs the cut when the financing rug gets pulled.

CY2027 OPPS/ASC Proposed Rule The sequel nobody asked for but everybody needs to understand: CMS wants to slash 340B drug payments by a third, speed up an old remedy clawback, and keep pushing more procedures out of hospitals and into lower-cost sites of care. A "routine" 2.4% headline number hides one of the more consequential outpatient rules in years. In part two of the trilogy, we go under the hood on the fights that'll actually move the needle for hospitals and health systems.

CY2027 Physician Fee Schedule

Every summer, CMS drops a rule that decides how much your practice gets paid—and this year's chapter has a twist nobody wanted: The conversion factor is falling even though the statutory update is technically positive. We break down the math behind the drop, the launch of the first mandatory specialist accountability model in Medicare history, and what it all means for the physicians actually billing these codes. This is Chapter 1 of our three-part dive into the rules reshaping 2027. Additional details and all episodes are available on the AMGA website.