Signal Timeline — Threads
The window's signals clustered into emergent threads, each named from its own language and placed on the causal cascade.
341 signals in the last 30 days
+1 more not labeled
Signals in this window
Showing the 100 most recent of 341 — see the Feed for the full archive.
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Amazon, Google among self-funded employers joining CMS' prior auth pledge
The Trump administration revealed Wednesday that five of the country's largest employers have signed on to expand electronic prior authorization in self-funded plans.
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Integris Health to join Kaiser Permanente's Risant Health
Pending approvals, Oklahoma's largest nonprofit health system will follow in the footsteps of Geisinger Health and Cone Health in seeking outside investment and tech-enabled value-based care know-how from the Kaiser subsidiary.
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CMS News: Trump Administration Announces $32 Million to Recruit Rural Doctors, Train Healthcare Workers and Expand Emergency Mental Healthcare Across Mississippi
Trump Administration Announces $32 Million to Recruit Rural Doctors, Train Healthcare Workers and Expand Emergency Mental Healthcare Across Mississippi This federal investment will help rural communities recruit healthcare professionals and establish three psychiatric emergency units to connect patients with timely behavioral healthcare
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Horizon BCBS to acquire Summit Health’s New Jersey business
Horizon Blue Cross Blue Shield of New Jersey has agreed to acquire multispecialty physician group Summit Health’s New Jersey operations, including CityMD urgent care sites in the state, the insurer confirmed to Becker’s. “We are excited by the opportunity to preserve access to high quality care for all of Summit Health’s patients, improve healthcare quality […] The post Horizon BCBS to acquire Summit Health’s New Jersey business appeared first on Becker's Payer Issues | Payer News .
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‘The market is reaping the benefits’ of BCBS antitrust settlement, Elevance says
Newly enabled competition between Blue Cross Blue Shield plans is continuing to contribute to Elevance Health’s commercial insurance business, leadership said on the company’s quarterly earnings call Oct. 21. Dubbed the “second blue bid,” the provision stems from a $2.67 billion settlement that resolved class action allegations dating back to 2012 that BCBS plans conspired […] The post ‘The market is reaping the benefits’ of BCBS antitrust settlement, Elevance says appeared first on Becker's...
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STAT+: CMS extends fraud crackdown to New York’s adult day care program
CMS is cracking down on adult day cares in New York, part of a broader focus on alleged health care fraud.
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Oracle, Amazon, Google among employers backing federal prior authorization reform push
Amazon, Axon, Google, Meta and Oracle are asking the insurers and third-party administrators that run their health plans to expand electronic prior authorization upgrades, first promised under a 2025 federal pledge, to the self-funded market. CMS and the Labor Department announced the employers’ statement of support Oct. 21. Self-funded employer plans aren’t subject to the […] The post Oracle, Amazon, Google among employers backing federal prior authorization reform push appeared first on Bec...
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Elevance’s new site-of-care rules puts hospitals on alert
As Elevance Health prepares to implement new site-of-care billing requirements, revenue cycle leaders are raising concerns about additional administrative burdens, potential payment delays and growing complexity across payers. “My broader concern is growing variation across payers, which adds cost and creates more chances for error,” Felix Segre, director of revenue integrity at Houston-based Memorial Hermann […] The post Elevance’s new site-of-care rules puts hospitals on alert appeared firs...
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CMS defers $1.2B in Medicaid funds from California, puts New York on notice after raid
The Trump administration is withholding additional funds from California as part of its war with certain states over Medicaid fraud.
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Baba nabs $40M series A, backed by FirstMark Capital and CVS Health Ventures, for AI-powered Medicare patient navigation
The AI company plans to use the funding to further its research, reach more health plans and accelerate value-based arrangements, executives say.
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Leading Employers Back Expansion of Electronic Prior Authorization to Self-Funded Health Plans
Leading Employers Back Expansion of Electronic Prior Authorization to Self-Funded Health Plans New employer support increases momentum to modernize prior authorization, reduce administrative burden across employer-sponsored coverage
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White House defers $1.2B more in California Medicaid payments
The White House is withholding another $1.2 billion in federal Medicaid payments to California, citing growth in the state’s personal care services spending. CMS Administrator Mehmet Oz, MD, made the announcement Oct. 20 in the Oval Office on behalf of HHS Secretary Robert F. Kennedy Jr. He pointed to concerns over California’s In-Home Supportive Services […] The post White House defers $1.2B more in California Medicaid payments appeared first on Becker's Payer Issues | Payer News .
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AHA comments to CMS on preliminary 2027 Medicare clinical laboratory fee schedule rates
The AHA submitted comments to the Centers for Medicare & Medicaid Services Oct. 21 on its preliminary calendar year 2027 Medicare clinical laboratory fee schedule rates. The AHA said the preliminary rates highlight the need for substantial reforms to CMS’ methodology, saying they are based on incomplete data. The AHA discussed the requirement under the Protecting Access to Medicare Act that called for hospital outreach laboratories and other clinical laboratories to report their private payer...
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CMS announces five organizations sign prior authorization pledge
The Centers for Medicare & Medicaid Services Oct. 21 announced that Amazon, Axon Enterprise, Inc., Google, Meta and Oracle Corp. are in support of its prior authorization pledge announced last year. The pledge involves streamlining prior authorization processes and increasing transparency for patients and providers by 2027. The AHA recently launched a new website on prior authorization, containing prior authorization news and resources. The website will be updated with additional resources an...
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SCAN senior exec departs
Lindsay Crawley-Herbert left her role as chief people and transformation officer at SCAN, according to an Oct. 20 LinkedIn post. “Over the years, I’ve had the privilege of being part of an extraordinary evolution,” she wrote. “We’ve grown, transformed, taken on hard challenges and continued to raise the bar on what’s possible. We’ve built new […] The post SCAN senior exec departs appeared first on Becker's Payer Issues | Payer News .
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New York payer says 2027 Medicare Advantage star rating will cost it $380M
Healthfirst is the latest insurer to sue the federal government in a bid to overturn its 2027 Medicare Advantage star rating it says will cost the plan more than $380 million. The New York City-based insurer, which has more than 300,000 MA enrollees, received a 3.5-star rating for 2027, down from 4.5 stars the prior […] The post New York payer says 2027 Medicare Advantage star rating will cost it $380M appeared first on Becker's Payer Issues | Payer News .
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Elevance reports $1.4B in Q3 profit, names Carelon president
Elevance Health logged nearly $1.4 billion in third-quarter profit for 2026, up 14.8% year over year. The company posted its earnings Oct. 21. That same day, Elevance named Jeff Park as president of healthcare services subsidiary Carelon, effective Dec. 1. Mr. Park was most recently president of health technology company Waltz Health. Along with other […] The post Elevance reports $1.4B in Q3 profit, names Carelon president appeared first on Becker's Payer Issues | Payer News .
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Elevance Health posts $1.4B in profit in Q3 earnings beat
Elevance Health is boosting its outlook for the year as it beat Wall Street analysts' expectations for both profit and revenue in the third quarter.
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Centene, Oscar, UnitedHealthcare sidle into some new counties in 2027 ACA plans
The major insurers are entering new Affordable Care Act markets as others are leaving the exchanges en masse, though in the cases of Centene and UnitedHealthcare, county additions paper over larger state exits.
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Elevance sees Medicaid momentum in Q3
States jacked up their Medicaid rates in July, a positive development for the insurer. Elevance now thinks its Medicaid margin will be better than its prior expectation of -1.75% this year.
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Privacy Act of 1974; Matching Program
In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), is providing notice of a computer matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA). The purpose of the matching program is to identify beneficiaries enrolled in both Medicare and VHA health care and to identify medical claims for which both agencies made pay...
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Centene, Oscar Health outline 2027 ACA marketplace plans
Open enrollment for the Affordable Care Act's marketplaces begins on Nov. 1, and with more turbulence on deck, insurers are offering a look at their plans for the coming year.
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‘Now’s the right time’: Why an Idaho health system is launching a Medicare Advantage plan
Boise, Idaho-based St. Luke’s Health System will begin offering Medicare Advantage coverage for the first time in 2027, making it one of just a handful of new entrants into the market. The launch comes as more than a dozen payers nationwide, including several prominent health systems, have made the decision to stop offering MA plans […] The post ‘Now’s the right time’: Why an Idaho health system is launching a Medicare Advantage plan appeared first on Becker's Payer Issues | Payer News .
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3 most feasible Medicare Advantage reforms: Study
As Medicare Advantage faces concerns regarding plan oversight, possible overpayments and care access, RAND researchers assembled experts to unpack potential reforms. Published in Health Affairs Oct. 5, the study consisted of two rounds with nearly 40 panelists. They rated 15 policy reform ideas on a nine-point scale. These ideas had high-level framing and were drawn […] The post 3 most feasible Medicare Advantage reforms: Study appeared first on Becker's Payer Issues | Payer News .
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SCAN partners with Mosaic’s CareMore on Medicare Advantage plan
SCAN Health Plan launched a Medicare Advantage HMO with CareMore Health, an integrated care delivery system and primary care provider under Mosaic Health, with coverage beginning Jan. 1. According to an Oct. 13 news release, CareMore Health Plan by SCAN will be available in California’s Los Angeles and Orange counties. Plan members will have access […] The post SCAN partners with Mosaic’s CareMore on Medicare Advantage plan appeared first on Becker's Payer Issues | Payer News .
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House bill targets Medicare Advantage star ratings methodology
A newly introduced House bill is targeting the methodology behind Medicare Advantage star ratings, adding more pressure to a program that has seen years of litigation from insurers. The Medicare Advantage Strengthening Transparency and Accountability in Rating Systems Act, or MA STARS Act, was introduced Sept. 21 by Rep. Mike Kelly, R-Pa., and would direct […] The post House bill targets Medicare Advantage star ratings methodology appeared first on Becker's Payer Issues | Payer News .
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Healthfirst Health Plan Inc. v. Department of Health and Human Services et al.
Medicare Advantage Star Ratings litigation. The post Healthfirst Health Plan Inc. v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .
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5 insurers launching new health plans
Medicare Advantage annual enrollment kicked off Oct. 15, and the ACA open enrollment period is around the corner. Employers are also navigating cost pressures, opening the door to innovative plans. Insurers have been primed to consider new health plans across commercial and government programs, and many are biting. Not every organization rolling out health plans […] The post 5 insurers launching new health plans appeared first on Becker's Payer Issues | Payer News .
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Judi Health launching employer Medicare Part D plan with a focus on transparency
Judi Health is launching a new Part D plan that aims to lean on its tech stack to drive transparency and outcomes.
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Judi Health launches Medicare Part D plan for employer groups
Health technology and benefits administration platform Judi Health is launching a Medicare Part D plan called Judi Rx Retire, according to an Oct. 20 news release. The product is a CMS-contracted and -approved Employer Group Waiver Plan, meaning employers can offer this prescription drug coverage to their Medicare-eligible retirees. Judi Rx Retire includes pharmacy networks, […] The post Judi Health launches Medicare Part D plan for employer groups appeared first on Becker's Payer Issues | Pa...
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CMS releases 2 qualifying payment amount audits
The Centers for Medicare & Medicaid Services Oct. 20 published two qualifying payment amount audits under the No Surprises Act. The audits were of CareSource in Indiana and the School Employees Retirement System in Ohio, with both required to complete corrective actions following the audits. The CareSource audit focused on almost 25,000 claims, primarily concerning emergency and non-emergency services, while the School Employees Retirement System audit focused on six air ambulance claims. Bot...
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Medicare broker eHealth could be delisted from Nasdaq
Health insurance brokerage company eHealth could be delisted from the Nasdaq stock exchange after the company’s shares closed below the $1 minimum bid price for 30 consecutive business days. In an Oct. 16 SEC filing, eHealth said it has until April 12, 2027, to regain compliance, which requires its shares to close at or above […] The post Medicare broker eHealth could be delisted from Nasdaq appeared first on Becker's Payer Issues | Payer News .
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UnitedHealthcare names chief marketing officer
Karen Deutsch is stepping into UnitedHealthcare’s chief marketing officer role, according to an Oct. 19 LinkedIn post. Ms. Deutsch has spent four years with the insurer, serving as chief marketing officer of government programs and, before that, of Medicare and retirement, according to her LinkedIn profile. She previously served in marketing leadership roles at U.S. […] The post UnitedHealthcare names chief marketing officer appeared first on Becker's Payer Issues | Payer News .
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CMS urges marketplace insurers to have brokers record consumer calls
Leading up to marketplace open enrollment, CMS issued guidance to insurers Oct. 19, encouraging greater oversight of agents and brokers. The memo focuses on issuers using the federally facilitated exchange. CMS expects issuers to follow much of the guidance beginning Nov. 1, when the enrollment period kicks off. CMS recommended that issuers have their agents […] The post CMS urges marketplace insurers to have brokers record consumer calls appeared first on Becker's Payer Issues | Payer News .
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Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026
This proposed rule would implement section 6219 (Adjustments to Medicare Part D Cost-Sharing Reductions for Low-Income Individuals), section 6220 (Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act), and section 6224 (Modernizing and Ensuring Pharmacy Benefit Manager Accountability) of the Consolidated Appropriations Act, 2026.
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Trump Administration Announces More Than $16 Million for Rural Healthcare Workforce Training and Retention Across Maryland
Trump Administration Announces More Than $16 Million for Rural Healthcare Workforce Training and Retention Across Maryland This federal investment will prepare Marylanders for healthcare careers and help rural communities recruit and retain nurses, physicians, dentists, and other providers
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Centene to leave Hawaii Medicaid program in 2027
Centene’s ‘Ohana Health Plan is leaving Hawaii’s Medicaid managed care program, QUEST, on Dec. 31, according to a Sept. 1 letter to plan members. Centene also did not bid on the contract for Community Care Services, a behavioral health managed care program. Centene’s work under this contract ends Oct. 31, according to a statement shared […] The post Centene to leave Hawaii Medicaid program in 2027 appeared first on Becker's Payer Issues | Payer News .
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CMS lifts enrollment freeze on Massachusetts Medicare Advantage plans
CMS lifted an enrollment freeze for two contracts under eternalHealth, a Boston-based Medicare Advantage insurer, on Oct. 7. The agency imposed the freeze Aug. 27 after determining eternalHealth’s conduct “poses a serious threat to enrollee health and safety.” Earlier that month, the Massachusetts Division of Insurance placed eternalHealth under administrative supervision and required the insurer […] The post CMS lifts enrollment freeze on Massachusetts Medicare Advantage plans appeared first...
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12% of calls to mental health clinicians in Blue Cross directories yield appointments: Study
Mental health ghost networks reach well beyond public insurance programs. Directory errors affected 55.6% of evaluable secret shopper calls to psychiatrists and psychologists listed by the largest commercial carrier in each of five states, according to a study published Oct. 16 in JAMA Health Forum. Researchers from the Ohio State University’s College of Public Health […] The post 12% of calls to mental health clinicians in Blue Cross directories yield appointments: Study appeared first on Be...
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CVS’ Oak Street Health gets chief medical officer
CVS Health named Maria Wilson, MD, as chief medical officer of Oak Street Health, the company’s value-based primary care centers for older adults. Dr. Wilson has been with Oak Street Health since 2017, most recently serving as an executive medical director, according to her LinkedIn profile. “It’s a privilege to take on this role in […] The post CVS’ Oak Street Health gets chief medical officer appeared first on Becker's Payer Issues | Payer News .
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CMS issues proposals to improve MA plan provider directory accuracy, PBM transparency requirements and reduce drug costs
The Centers for Medicare & Medicaid Services released a proposed rule Oct. 16 seeking to codify regulations that will improve the accuracy of Medicare Advantage plan provider directories, establish transparency and compensation requirements for pharmacy benefit managers and their affiliates, and reduce copayments for generic drugs to $0 for low-income Medicare Part D beneficiaries. Among the proposed rule’s provisions, it would require MA plans to verify and update their provider directory in...
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Maryland payer laying off 161 across 3 states
Provider Partners Health Plans is laying off 161 employees spanning three states, according to Oct. 7 Worker Adjustment and Retraining Notification, or WARN, notices. Provider Partners reported 79, 39 and 43 layoffs in Texas, Maryland and Illinois, respectively. The Texas and Maryland layoffs go into effect in early December. In late May, CMS said it […] The post Maryland payer laying off 161 across 3 states appeared first on Becker's Payer Issues | Payer News .
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UnitedHealth’s subsidiary count gets bigger
UnitedHealth Group’s count of subsidiaries and related entities has reached 2,807, according to the latest “Sunlight Report,” published in October. The report comes from the Center for Health & Democracy and is funded by Arnold Ventures. The updated report identified more entities since the findings published in July 2025, factoring in 2024 year-end and 2025 […] The post UnitedHealth’s subsidiary count gets bigger appeared first on Becker's Payer Issues | Payer News .
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‘Don’t look at this as just a one-time product launch’: Cigna exec on Health Sense’s rollout
Cigna Healthcare in the first quarter of 2027 will roll out Health Sense, a tailored customer and clinical support model that brings together health, benefits and cost information. While the model will initially roll out for customers with oncology and cardiometabolic needs, Stanley Crittenden, MD, chief medical officer at Cigna Healthcare, told Becker’s that the […] The post ‘Don’t look at this as just a one-time product launch’: Cigna exec on Health Sense’s rollout appeared first on Becker'...
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No one filed to run in a special Isle of Wight election. What happens now?
By Mechelle Hankerson / WHRO When Isle of Wight voters scan their ballot this election season, they’ll notice something different: Instead of names next to bubbles, voters will find a space to write in a name for recently vacated school board seat. Former school board member Brandi Perkins resigned from the board on July 31. […]
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CMS proposes rule to clean up MA provider directories, shine light on PBMs
The proposed changes would implement key healthcare provisions in a government funding package from February. The brunt of the reforms would go into effect in 2028.
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CMS proposes MA 'ghost network,' PBM transparency requirements
The administration took steps to codify statutory reforms focused on maintaining accurate Medicare Advantage provider directories and collecting more pricing information from pharmacy benefit managers.
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General Motors to transition from BCBS Michigan to Aetna for salaried employees
One of Michigan’s largest employers, General Motors, is switching from Blue Cross Blue Shield of Michigan to Aetna for the administration of salaried, non-unionized employees’ health plans, as reported Oct. 8 by the Detroit Free Press and The Detroit News. An Aetna website confirmed the insurer will “become GM’s national medical carrier” starting in 2027. […] The post General Motors to transition from BCBS Michigan to Aetna for salaried employees appeared first on Becker's Payer Issues | Paye...
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CMS proposes public scores for Medicare Advantage provider directories, flat-fee limits for PBMs
CMS is pitching new guardrails for pharmacy benefit managers and Medicare Advantage plans under a proposed rule released Oct. 16. The proposed rule would implement sections of the Consolidated Appropriations Act of 2026. Comments are due Dec. 15. Here are eight things to know from the proposed rule: The post CMS proposes public scores for Medicare Advantage provider directories, flat-fee limits for PBMs appeared first on Becker's Payer Issues | Payer News .
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Trump Administration Announces $92 Million to Coordinate Rural Hospital Networks, Improve Maternal Care, and Expand Medical Services Across Ohio
Trump Administration Announces $92 Million to Coordinate Rural Hospital Networks, Improve Maternal Care, and Expand Medical Services Across Ohio This federal investment will connect rural providers and bring MRI, behavioral health, and maternal care closer to patients across Ohio
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CMS Proposes Reforms to Strengthen Transparency and Affordability in Medicare Advantage and Part D
CMS Proposes Reforms to Strengthen Transparency and Affordability in Medicare Advantage and Part D The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would improve the accuracy of provider directories for Medicare Advantage plans, establish transparency and compensation requirements for Pharmacy Benefit Managers (PBMs), and deliver enhanced cost-saving protections for low-income Medicare beneficiaries.
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Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026 (CMS-4214-P)
Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026 (CMS-4214-P) Background
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Trump Administration Announces More Than $11 Million to Strengthen Rural EMS and Expand Mobile Healthcare Across New Hampshire
Trump Administration Announces More Than $11 Million to Strengthen Rural EMS and Expand Mobile Healthcare Across New Hampshire This federal investment will create and expand mobile health programs, connect EMS agencies with rural hospitals, and bring more care directly to patients across New Hampshire
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Minnesota may need to claw back Medicaid funds from providers
The Minnesota Department of Human Services told Becker’s Oct. 15 that it may need to claw back funds from Medicaid providers if it faces a disallowance from CMS in the coming weeks. CMS has deferred $550 million in Medicaid funds to the state, according to an Oct. 2 letter from Minnesota DHS Temporary Commissioner John […] The post Minnesota may need to claw back Medicaid funds from providers appeared first on Becker's Payer Issues | Payer News .
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Closing the Post-Discharge and Readmission Gap:How Me+U Care Modernizes Member Communications for Health Plans
In today’s highly regulated landscape, health plans face increasing pressure to deliver timely, interactive outreach after a covered patient’s hospital discharge. Federal and state regulators require Medicare Advantage and Medicaid Managed Care Organizations to document every attempt and prove that outreach occurred within strict timelines. Medicare Advantage plans must complete outreach within two business days. […] The post Closing the Post-Discharge and Readmission Gap:How Me+U Care Modern...
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Fierce Healthcare Regulatory Recap: HHS presses medical groups on gender-affirming care for minors; CMS distributes RHTP funding to 5 states
The latest news from CMS and HHS this week: HHS demands info on ‘sex-rejecting procedures’ for minors, CMS releases more RHTP funds and more.
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Trump Administration Announces New Funding to Expand Rural EMS and Bring More Care Directly to Patients Across Montana
Trump Administration Announces New Funding to Expand Rural EMS and Bring More Care Directly to Patients Across Montana This federal investment will give rural emergency medical teams the tools to provide in-home care, manage chronic conditions, and help Montanans avoid unnecessary emergency visits
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CHOICE in Action: Ohio Employers Explore New Approach to Health Benefits
CHOICE in Action: Ohio Employers Explore New Approach to Health Benefits Federal leaders spotlight CHOICE Arrangement to aid Ohio small businesses in delivering flexible and affordable healthcare to workers
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Healthcare software company owner sentenced in $1B Medicare fraud scheme
The owner of healthcare software company HealthSplash was sentenced to 19 years in prison for his role in a scheme that prosecutors said fraudulently billed Medicare and other federal healthcare programs more than $1 billion for medically unnecessary equipment. Brett Blackman, 43, of Johnson County, Kan., was sentenced Oct. 14 after being convicted in April […] The post Healthcare software company owner sentenced in $1B Medicare fraud scheme appeared first on Becker's Payer Issues | Payer News .
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CMS opens petition period for 5 independent dispute resolution entities seeking recertification
The Centers for Medicare & Medicaid Services announced that the submission period opened Oct. 16 for petitions to deny the recertification of five independent dispute resolution entities. Members of the public, providers, facilities and others can submit a petition, which must identify the IDR entity seeking recertification and detail the reasons for the petition. The five organizations seeking recertification are Maximus Federal Services, Inc.; ProPeer Resources LLC; C2C Innovative Solutions...
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CMS to exercise enforcement discretion regarding initial interdisciplinary team meeting requirement for IRF admissions
The Centers for Medicare & Medicaid Services announced that it will exercise enforcement discretion for inpatient rehabilitation facility admissions from Oct. 1, 2026 through March 31, 2027, with respect to the timing of the initial interdisciplinary team meeting requirement. As of Oct. 1, the initial IDT meeting must occur on or before four days from the date a patient is admitted to an IRF in order to implement appropriate treatment services; establish or review the patient’s stated rehabil...
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CMS wants to quadruple provider suspensions in 6 months
A top CMS official wants provider suspensions to quadruple in the next six months as the agency puts new exclusion authority to work and tests AI tools to catch fraud, Nextgov/FCW reported Oct. 15. CMS Deputy Administrator Kimberly Brandt discussed the agency’s enforcement efforts Oct. 15 at the ADAPT conference in Santa Fe, N.M. Ms. […] The post CMS wants to quadruple provider suspensions in 6 months appeared first on Becker's Payer Issues | Payer News .
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Centene to expand CHOICE program to its Ohio, Oklahoma employees
Centene is expanding Custom Health Option and Individual Care Expense Arrangements, formerly known as individual coverage health reimbursement arrangements, to all of its Ohio and Oklahoma employees in plan year 2027. An Oct. 16 news release said the development builds on the company’s CHOICE rollout to Indiana-based employees in 2026. “Our experience in Indiana has […] The post Centene to expand CHOICE program to its Ohio, Oklahoma employees appeared first on Becker's Payer Issues | Payer Ne...
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Where Optum’s financials stand after rolling back ‘rapid expansion’
A year after executives said Optum Health had drifted from its original value-based care model, the smaller business is producing much larger profits, according to UnitedHealth Group’s Oct. 13 earnings release and call. Optum Health’s earnings from operations rose to $735 million in the third quarter, up from $41 million a year earlier. Its operating […] The post Where Optum’s financials stand after rolling back ‘rapid expansion’ appeared first on Becker's Payer Issues | Payer News .
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Agent, broker group sues CMS to block ACA registration freeze
The National Association of Benefits and Insurance Professionals filed a lawsuit against CMS and HHS on Oct. 15 concerning a temporary freeze on new agent and broker registrations with federally facilitated exchanges for 2027. CMS instituted the freeze under an interim final rule in September, which immediately went into effect and could run until Feb. […] The post Agent, broker group sues CMS to block ACA registration freeze appeared first on Becker's Payer Issues | Payer News .
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Voice AI startup careCycle rolls out free plan comparison tool for Medicare beneficiaries
The tool is free to use, takes no payments from payers or commissions and does not sell or share personal information. It surfaces yearly cost estimates and shows nearby plans that keep a patient's doctors in-network.
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Agency Information Collection Activities: Proposed Collection; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Int...
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NABIP sues CMS over moratorium on new ACA broker registrations
The National Association of Benefits and Insurance Professionals is suing the Trump administration over its moratorium on new brokers entering the Affordable Care Act marketplaces.
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Blue Shield of California adds former Lyft CFO to board
Erin Brewer is joining Blue Shield of California’s board of directors. Ms. Brewer had served as CFO of Lyft since 2023, and she now serves the company in an advisory capacity. Previously, she held leadership roles at Charles Schwab, Atlassian, and McKesson Corp. An Oct. 15 news release said her experience across industries will contribute […] The post Blue Shield of California adds former Lyft CFO to board appeared first on Becker's Payer Issues | Payer News .
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Catching up with Blue Shield of California CEO Mike Stuart one year in
In August 2025, Blue Shield of California named Mike Stuart as its CEO. Now, a year later, he's reflecting on months of work toward addressing affordability, member access and the patient journey.
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CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in Alabama and Florida
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in Alabama and Florida The Centers for Medicare & Medicaid Services (CMS) announced today additional resources and flexibility available in response to a Public Health Emergency (PHE) in Alabama, beginning Oct. 7, 2026, and Florida, beginning Oct. 6, 2026, respectively, due to emergency conditions resulting from Hurricane Isaias and continuing. CMS is working closely with both states and federal partners to put flex...
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UnitedHealth Group appoints chief marketing officer
Rocky Novak is joining UnitedHealth Group as chief marketing officer, effective Oct. 29. According to an Oct. 15 statement shared with Becker’s, Mr. Novak will lead enterprise marketing strategy, deepen stakeholder engagement and manage brands across UnitedHealth. “Rocky will work with leaders and teams across UnitedHealth Group to strengthen how the company engages in the […] The post UnitedHealth Group appoints chief marketing officer appeared first on Becker's Payer Issues | Payer News .
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The best Medicare Advantage companies for 2027: US News
Kaiser Permanente led the 2027 U.S. News & World Report ratings for the “best overall” Medicare Advantage companies. The ratings, published Oct. 14, are based on a five-point scale, assigning weights to more than 30 CMS quality measures. After calculating contract ratings, U.S. News determined enrollment-adjusted average ratings for carriers. U.S. News considered MA companies […] The post The best Medicare Advantage companies for 2027: US News appeared first on Becker's Payer Issues | Payer N...
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Elevance Health Foundation launched a prize program for patient safety initiatives. Here's why
The Elevance Health Foundation has launched a new prize program aimed at supporting solutions aimed at improving patient safety, with the first crop of winners targeting challenges like health literacy, fall prevention and medication errors.
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CMS News: Trump Administration Announces $78 Million for Rural Healthcare Workforce, Chronic Disease Prevention, and Facility Upgrades Across Texas
Trump Administration Announces $78 Million for Rural Healthcare Workforce, Chronic Disease Prevention, and Facility Upgrades Across Texas These investments will support the rural health workforce, modernize aging equipment, and advance chronic disease prevention to keep quality care within reach for rural Texans.
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AHA launches new website on prior authorization
As major provisions of the 2024 Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule take effect on Jan. 1, 2027, hospitals and health systems are advised to begin preparing for significant changes to prior authorization workflows, payer interactions and information exchange. The AHA’s new website on prior authorization contains news and resources about prior authorization, both in general and as the final rule’s deadline approaches. The website will be...
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CMS reinstates some ACA enrollees after cutting 760,000 people
CMS has reinstated a small number of enrollees who lost coverage after the agency canceled ACA policies for more than 760,000 people, according to a KFF Health News report published Oct. 15 in NPR. KFF Health News learned of the reinstatements through insurance industry sources, finding that not all of those who lost coverage were […] The post CMS reinstates some ACA enrollees after cutting 760,000 people appeared first on Becker's Payer Issues | Payer News .
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Seniors Shouldn’t Have to Brace for Disruption Every October
As Medicare Open Enrollment Begins, Better Medicare Alliance Calls on Policymakers to Deliver Lasting Stability for Medicare Advantage Lower 2027 premiums show what stable funding can do. Rising out-of-pocket costs, … Continue reading "Seniors Shouldn’t Have to Brace for Disruption Every October" The post Seniors Shouldn’t Have to Brace for Disruption Every October appeared first on Better Medicare Alliance .
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One Platform, Not Five Vendors: How Growing Health Plans Are Consolidating Payer Technology
Most health plans did not set out to build a patchwork of vendors. It happened one urgent need at a time: a risk adjustment tool here, a quality reporting platform there, a separate chart retrieval vendor, and yet another system for regulatory submissions. Each decision made sense on its own. Together, they leave a growing […] The post One Platform, Not Five Vendors: How Growing Health Plans Are Consolidating Payer Technology appeared first on Becker's Payer Issues | Payer News .
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Louisiana opens enrollment for 274,000 Medicaid recipients who must switch plans
Healthy Blue, offered by Blue Cross Blue Shield of Louisiana and Elevance Health, is pulling out of Louisiana’s Medicaid program at the end of the year.
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Centene unveils national provider gold card program
Centene is aiming to simplify the prior authorization process with the launch of a new nationwide gold card program.
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8 things to know about 2027 Medicare Advantage star ratings
CMS released 2027 Medicare Advantage star ratings on Oct. 8, giving more insight into the MA landscape beyond health plans’ marketing materials. Contracts receive a rating each year, ranging from one to five stars. The ratings help beneficiaries compare plans, but they also shape quality bonus payments to boost benefits. Four stars is the main […] The post 8 things to know about 2027 Medicare Advantage star ratings appeared first on Becker's Payer Issues | Payer News .
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Cigna accused of underpaying ground ambulances to boost its own fees
Cigna is facing a lawsuit claiming it made a profit by underpaying out-of-network ground ambulances, according to a class-action complaint filed Oct. 12 in a California federal court. The lawsuit centers on self-funded employer health plans that Cigna administers under administrative services only agreements. The plaintiff, who was covered by one of these plans, alleged […] The post Cigna accused of underpaying ground ambulances to boost its own fees appeared first on Becker's Payer Issues |...
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CMS takes aim at duplicative ACA, Medicaid enrollments
The Trump administration has put a focus on rooting out fraud, waste and abuse, and on Wednesday, regulators offered a look at progress to date in those efforts.
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Trump Administration Delivers Second Year of Savings by Stopping Taxpayer Payments for Duplicate and Deceased Enrollees in Obamacare
Trump Administration Delivers Second Year of Savings by Stopping Taxpayer Payments for Duplicate and Deceased Enrollees in Obamacare After Years of Biden-era Inaction, CMS Reviews Projected to Save Taxpayers $1.5 Billion Over the Next Year The Centers for Medicare & Medicaid Services (CMS) continue to crush fraud, waste, and abuse in America’s healthcare programs by stopping duplicative enrollment in government health programs, with the potential to save taxpayers approximately $1.5 billion o...
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CMS can now exclude providers from Medicare, Medicaid: 7 things to know
CMS can now exclude individual providers and entities from participating in federal healthcare programs, including Medicare and Medicaid. HHS Secretary Robert F. Kennedy Jr. delegated the authority to the CMS administrator in a notice that took effect immediately. Here are seven things to know: 1. The notice was published in the Federal Register on Oct. […] The post CMS can now exclude providers from Medicare, Medicaid: 7 things to know appeared first on Becker's Payer Issues | Payer News .
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CMS ends ACA subsidies for 189,000 duplicate or deceased enrollees: 5 notes
CMS ended subsidies in 2026 for 189,000 people with federally subsidized marketplace coverage who also had Medicare, Medicaid or Children’s Health Insurance Program coverage, or who were deceased, HHS said Oct. 14. Here are five things to know: 1. The Trump administration in 2025 restored duplicate enrollment enforcement and ended duplicate marketplace subsidies for about […] The post CMS ends ACA subsidies for 189,000 duplicate or deceased enrollees: 5 notes appeared first on Becker's Payer...
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No Surprises Act arbitration awards near 6% of commercial medical spend in some regions: UnitedHealthcare
Arbitration awards under the No Surprises Act can reach nearly 6% of total commercial medical spend in some regions, UnitedHealthcare CEO Tim Noel said during an Oct. 13 earnings call. The medical cost trend for UnitedHealthcare’s commercial business is “exceeding” an initial expectation of 11%, Mr. Noel said. While Mr. Noel pointed to clinician cost […] The post No Surprises Act arbitration awards near 6% of commercial medical spend in some regions: UnitedHealthcare appeared first on Becker'...
UnitedHealthcare -
CVS to pay $315M over opioid prescriptions billed to Medicare, federal programs: Justice Department
CVS Pharmacy has agreed to pay $315 million to resolve Justice Department allegations that it illegally filled opioid and other controlled substance prescriptions, according to an Oct. 13 news release. Here are five things to know: The post CVS to pay $315M over opioid prescriptions billed to Medicare, federal programs: Justice Department appeared first on Becker's Payer Issues | Payer News .
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Insurers, AMA join forces on provider directory data standard
DataSpring, powered by CAQH, assembled a collective of insurers, along with the American Medical Association, to launch a new standard to measure provider directory data quality for individual clinicians on Oct. 13. DataSpring, owned by major health insurers, bridges payer and provider data. Along with DataSpring and the AMA, the Provider Data Collective includes Aetna, […] The post Insurers, AMA join forces on provider directory data standard appeared first on Becker's Payer Issues | Payer N...
Aetna -
CMS delegated exclusion authorities for Medicare, Medicaid
The Department of Health and Human Services has delegated the Centers for Medicare & Medicaid Services certain statutory authorities to exclude individuals and entities from federal healthcare programs, including Medicare and Medicaid, effective immediately, HHS announced in a Federal Register notice. The delegation grants CMS similar authority to exclude and permanently ban providers as the HHS Office of Inspector General has following investigations. “As the agency directly responsible for...
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Optum Health’s turnaround picks up speed
Optum Health’s earnings from operations climbed to $735 million in the third quarter, up from $41 million a year earlier, as UnitedHealth Group’s care delivery arm continues to recover from a challenging 2025. The unit’s operating margin rose to 3.2% from 0.2%, according to UnitedHealth’s Oct. 13 earnings release. On an adjusted basis, the margin […] The post Optum Health’s turnaround picks up speed appeared first on Becker's Payer Issues | Payer News .
UnitedHealthOptum -
AHA pushes back on Blue Cross report tying AI to $942M in coding costs
The American Hospital Association is challenging a Blue Cross Blue Shield Association analysis that estimated rising hospital coding intensity added $942 million in costs and linked the trend to AI-enabled billing tools. The AHA argued in an Oct. 5 blog post that rising coding intensity reflects older, more complex patients, not improper billing. The organization […] The post AHA pushes back on Blue Cross report tying AI to $942M in coding costs appeared first on Becker's Payer Issues | Payer...
Blue CrossBlue Shield -
Trump Administration Announces New Funding to Support Early Career Physicians Who Choose to Work in Rural Delaware
Trump Administration Announces New Funding to Support Early Career Physicians Who Choose to Work in Rural Delaware This federal investment will award housing and assistance to help future physicians train and practice in rural communities, ensuring Delawareans get the care they need close to home.
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Centene joins insurers waiving prior authorizations for top providers
Centene is the latest insurer to adopt a gold card program as states and the Trump administration push for prior authorization reform.
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Poll: 43 percent support 'Medicare for all'
Nearly 43 percent of Americans support the idea of “Medicare for all,” according to an Axios/Ipsos poll released Tuesday, as concerns over health costs mount ahead of the midterm elections. People who said they support Medicare for all outnumbered its opponents by a nearly 2-to-1 margin, while a bipartisan majority of Americans said they think the...
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CVS, DOJ reach $315M settlement in opioid prescription case
CVS Health has reached a $315 million settlement with the Department of Justice that resolves allegations the pharmacy giant knowingly filled unlawful opioid prescriptions.
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Trump Administration Announces New Funding to Support Rural Healthcare Workers and Expand Maternal Care Across Missouri
Trump Administration Announces New Funding to Support Rural Healthcare Workers and Expand Maternal Care Across Missouri Federal investment will expand childcare support for rural healthcare workers and launch nurse midwife training to help address maternal care gaps across Missouri
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STAT+: BlackRock to buy majority stake in Humana’s CenterWell clinics for $2.8 billion
Humana is swapping out private equity sponsors for its CenterWell Senior Primary Care clinics. Good bye, Welsh, Carson, Anderson & Stowe. Hello, BlackRock.
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CVS to pay $315M settlement over allegations of illegally filling opioid prescriptions
The Justice Department (DOJ) announced Tuesday that CVS Health has agreed to pay $315 million to settle lawsuits alleging the company illegally filled prescriptions for opioids and other controlled substances. The settlement resolves a lawsuit first filed in 2019 by former CVS employee Hillary Estright in 2019 under the whistleblower provision of the False Claims...
CVS Health