Judge Strikes Piece of Work Requirements Regulation
A federal judge backed a coalition of states in an ongoing lawsuit over the rollout of Medicaid work requirements. It struck the Trump administration’s definition of “medical frailty” for critical exemptions.
The judge said a regulation unlawfully limited the group of people who would qualify as “medically frail” and would thus be exempted. The Centers for Medicare & Medicaid Services (CMS) regulation said that the frailty exemption would apply when a “physical, mental, or other behavioral health condition significantly impairs the individual’s ability to comply with the community engagement requirement.”
States will receive a six-month enforcement stay on medical frailty determinations, as the ruling may require changes to verification systems. The remainder of the work requirements rule stays intact for a Jan. 1 implementation timeline.
Additional articles: https://www.fiercehealthcare.com/payers/26-states-sue-cms-over-final-medicaid-work-requirements-rule and https://www.beckerspayer.com/payer/medicaid/judge-rules-cms-overstepped-on-medically-frail-definition-for-medicaid-work-requirements/ and https://thehill.com/policy/healthcare/6182258-judge-strikes-trump-medicaid-definition/
#medicaid #workrequirements
https://www.modernhealthcare.com/politics-regulation/mh-court-cms-medicaid-medical-frailty
Trump Admin Finalizes PBM Reform For Employers
The Trump administration finalized a regulation that requires pharmacy benefit managers (PBMs) to disclose fees and compensation to self-funded employers as well as other transparency requirements.
In part, the regulation ensures that employers receive reports on what drug manufacturers, pharmacies, and other entities are paying their PBMs and any affiliated brokers and consultants. PBMs must disclose several key sources of compensation, including manufacturer rebates, any compensation when the price for a drug paid by the plan exceeds reimbursement to the pharmacy, and any payments recouped from pharmacies for dispensed drugs.
Additional article: https://www.fiercehealthcare.com/regulatory/labor-department-finalizes-pbm-transparency-rule and https://www.healthcaredive.com/news/pbm-transparency-final-rule-labor-department-employer/873089/
#employercoverage #pbms
https://www.modernhealthcare.com/politics-regulation/mh-labor-department-pbm-transparency-rule
Tenet Has Strong Performance
Tenet Healthcare reported strong performance across its hospital and ambulatory businesses during Q3 2026 and raised earnings guidance by 4%. Unlike HCA, Tenet does not appear to have suffered deep issues with Exchange enrollment losses.
#hospitals #margins
— Marc S. Ryan
