The fights

The eight pillars

The Federation of American Hospitals' documented positions on the eight policy fights that decide whether physician-owned hospitals and independent physicians can compete.

Record as of November 6, 2026

Pillar 01

Low

CON Laws

Certificate of need · Market entry · State regulation

FAH position: No position found. FAH filed no statement, letter, comment or testimony on certificate of need from January 2025 through November 6, 2026. Its May 2025 letter to the FTC and DOJ on anticompetitive regulation does not mention CON.

Now: Cicero Institute's 2026 ranking: 25 states acted on CON in 2026 sessions. Rhode Island, Iowa and Delaware repealed entire categories.

Pillar 02

Moderate

Hospital Consolidation

FTC authority · Merger review · Noncompetes

FAH position: FAH argues hospital mergers are needed for survival and opposes expanded federal and state premerger reporting. It asks the FTC to treat physician and executive noncompetes as presumptively lawful.

Now: A federal court in Texas vacated the FTC's 2024 expanded Hart-Scott-Rodino premerger form. AHA and FAH had filed an amicus brief for the plaintiffs in August 2025.

Pillar 03

Low

340B Drug Pricing

The 340B program · Contract pharmacy · Medicare payment

FAH position: FAH says its taxpaying members derive no benefit from 340B discounts. It urged CMS to finalize the 340B payment cut and opposes only the recoupment that offsets the 2018 to 2022 remedy.

Now: CMS's CY2027 outpatient final rule pays 340B-acquired drugs at ASP minus 28% from January 1, 2027, based on a 2026 acquisition cost survey. CMS estimates a $4.35 billion cut in Medicare drug payments in year one, redistributed to non-drug services.

Pillar 04

Low

No Surprises Act / IDR

Independent dispute resolution · QPA · Out-of-network

FAH position: FAH supports the No Surprises Act and blames insurer underpayment for dispute volume. It welcomed the 2026 operations rule. It has joined amicus briefs against the QPA-anchored rules and for enforcement of awards.

Now: The federal IDR operations final rule took effect August 3, 2026. The administrative fee fell from $115 to $15 per party for disputes started on or after June 11, 2026. Plans must disclose QPA information and use standard remittance codes.

Pillar 05

Critical

Physician-Owned Hospital Ban

Section 6001 · Stark Law · Repeal bills

FAH position: FAH urges Congress to maintain current law limiting physician self-referral and calls the ban essential to uphold. It cites conflicts of interest and harm to full-service community hospitals.

Now: Section 6001 remains in force. No new physician-owned hospital may use the whole-hospital exception, and grandfathered hospitals are frozen at their 2010 bed, operating room and ownership levels. No 119th Congress bill to change it has had a hearing or markup.

Pillar 06

High

Site-Neutral Payments

Payment parity · Hospital outpatient vs. physician office · Medicare

FAH position: FAH opposes every site-neutral expansion. It told CMS in August 2026 that the imaging cut is unlawful and improper and that blunt site-neutral policies ignore hospital cost structures.

Now: CMS's CY2027 outpatient final rule pays imaging without contrast at excepted off-campus hospital departments at the physician fee schedule rate. That is 40% of the hospital rate, from January 1, 2027. CMS estimates $260 million in first-year savings. FAH's comment opposed the cut for 337 imaging services.

Pillar 07

Low

Scope of Practice

Nurse practitioners · Physician assistants · State practice acts

FAH position: No position found. FAH has no documented public position on scope of practice in 2025 or 2026. That covers nurse practitioners, physician assistants, nurse anesthetists, pharmacists and allied health professionals.

Now: FAH's public comments archive for January 2025 through November 2026, 49 letters, contains no scope of practice comment. The closest is the November 2025 FTC noncompete letter, which concerns employment, not practice authority.

Pillar 08

Moderate

Price Transparency

Hospital price files · Shoppable services · Insurer disclosure

FAH position: FAH says it supports transparency that gives patients meaningful information. It asks CMS to keep the hospital rules in their current form and tells Congress that patients' costs are dictated primarily by insurers.

Now: Executive Order 14221 directed Treasury, Labor and HHS within 90 days to require disclosure of actual prices, not estimates, and to enforce the 2019 order.