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.

AMGA's public policy team runs through Capitol Hill happenings as rising healthcare costs and consolidation draw more attention from Congress and the Trump Administration. This episode covers current financial pressures on providers, including H.R. 1 Medicaid implementation, Medicare reimbursement, site-neutral payment proposals, and increased oversight. It also dives into other Congressional focus areas such as physician payment reform, rural workforce issues, and price transparency.

Fresh off Capitol Hill Day 2026, the AMGA policy team sits down to unpack the event with candid takeaways on how conversations with lawmakers have shifted this year. The team breaks down the issues dominating discussions, key bills moving through Congress, and what policymakers and their staff are asking for: real numbers, real stories, and the real impact on practices.

Lauren and Darryl unpack one of the more consequential conversations AMGA has had in recent memory: CMMI Director Abe Sutton's meeting with AMGA's Board of Directors. Darryl breaks down Sutton's priorities — a push for downside risk, longer and more stable model designs like the new LEAD model, and a genuine interest in using AI as a workforce extender in the face of a looming clinician shortage. Lauren draws the comparison to Adam Boehler's tenure and asks what's really different this time. The bottom line: Sutton heard AMGA's years of feedback on predictability and stability, and he said so directly. Now it's on AMGA and its members to show up, share what's working, and help shape what comes next — because as Lauren puts it, Sutton appears to be “willing and able” to do exactly that.

Lauren and Darryl are co-piloting this week’s Filibusters and Fine Print, where they discuss Congress’s continued focus on healthcare affordability and the likelihood of a major healthcare payment stability package passing this year. The flight includes stops at the AMGA Annual Conference in Vegas, the famed Ways and Means Committee room in DC, and visits to our friends in the Energy and Commerce Committee and the GOP and Dem DOC Caucus. Expect some turbulence on the landing, some old legislative baggage to resurface, and some government interference. We hope you'll fly with us again soon.

Affordability reform is coming but will Congress support positive policy reforms or undermine it? In this episode, we examine the latest congressional hearing on provider-driven health care costs through an AMGA lens. As policymakers scrutinize pricing, consolidation, and payment differences, we explore how these debates intersect with AMGA’s core legislative and regulatory priorities.