Timeline — Policy / Regulatory Changes
Signals in this topic on one timeline — one payer bubble row apiece, all in this topic's color.
140 signals in the last 30 days
Signals in this window
Showing the 100 most recent of 140 — 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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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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‘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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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...
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1.1 million Medicare beneficiaries signed up for GLP-1 Bridge model
Roughly 1.1 million Medicare beneficiaries have signed up to access discounted GLP-1s through CMS’ Bridge model, HHS Chief Counselor Chris Klomp said during an Oct. 7 Wall Street Journal event. The pilot launched July 1, rolling out to Medicare Part D beneficiaries who meet specific clinical criteria. The pilot intends to reach beneficiaries needing anti-obesity […] The post 1.1 million Medicare beneficiaries signed up for GLP-1 Bridge model appeared first on Becker's Payer Issues | Payer News .
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Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al. (Alignment II)
Medicare Advantage Star Ratings litigation. The post Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al. (Alignment II) appeared first on Health Care Litigation Tracker .
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Alignment Healthcare sues CMS over its 2027 Medicare Advantage star ratings
Alignment Healthcare sued federal regulators, alleging that its 2027 Medicare Advantage star ratings were determined "in flagrant violation" of statute.
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Payers face a choice on price transparency: Comply or adopt
CMS shared its Transparency in Coverage rulemaking — formed in partnership with the Labor and Treasury departments — on Oct. 5. Now, payers are reckoning with the changes. The rule updated previous regulations introduced by the Trump administration in 2020, such as a requirement for payers to post negotiated rates. The recent rule cuts so-called […] The post Payers face a choice on price transparency: Comply or adopt appeared first on Becker's Payer Issues | Payer News .
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ACHP Recommendations for an Inferred Risk Adjustment Model
ACHP urges CMS to preserve separate payment terms for state directed payments and coordinate with NAIC so risk-based capital reflects the risk plans bear. Source
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From policy to practice: How health plans can operationalize CMS payment integrity changes
CMS is reshaping how health plans approach payment integrity. Faster regulatory cycles along with heightened scrutiny of improper payments have resulted in expanded audits for providers and payers. This represents a greater emphasis on prevention and real-time intervention as increasing pressure on payers to ensure medical claims are reimbursed accurately. Today’s challenge goes far beyond […] The post From policy to practice: How health plans can operationalize CMS payment integrity changes...
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Humana rebounds, Aetna slips: Winners and losers in the 2027 MA star ratings
Federal regulators released the hotly anticipated star ratings for the 2027 Medicare Advantage plan year, and winners and losers emerged in the data.
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Fierce Healthcare Regulatory Recap: CMS releases 2027 MA star ratings; HHS awards $28M for falls prevention
The latest news from CMS, HHS and more across Washington, D.C.
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‘Somebody cares about this enough’: What the ICHRA-to-CHOICE rebrand means
In September, CMS rebranded individual coverage health reimbursement arrangements as CHOICE arrangements, short for Custom Health Option and Individual Care Expense. The ICHRA benefits model first launched in 2020. Through the model, employers give workers fixed, tax-free contributions to buy individual health insurance. The CHOICE rebrand has been a long time coming. The CHOICE name […] The post ‘Somebody cares about this enough’: What the ICHRA-to-CHOICE rebrand means appeared first on Beck...
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ACHP Members Lead 2027 Star Ratings and NCQA Ratings
ACHP member plans averaged 4.23 Stars in 2027 Medicare Advantage Star Ratings, vs. 3.96 for other plans, and earned 13 of 18 five-star NCQA ratings. Source
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STAT+: Medicare Advantage star ratings trigger new bonuses, and uncertainty
The federal government has released new quality ratings for Medicare Advantage insurers for 2027, with Humana emerging as the biggest winner. But deep uncertainty remains around Medicare Advantage quality measures,…
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Humana’s star ratings turnaround: 5 notes
Humana has pulled off a Medicare Advantage star ratings turnaround, with 95% of the insurer’s members in plans rated four stars or higher for 2027, compared to 20% a year ago. “I’m grateful for what our team accomplished this year, and we’re already looking at what’s next and pushing ourselves to do even more for […] The post Humana’s star ratings turnaround: 5 notes appeared first on Becker's Payer Issues | Payer News .
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Better Medicare Alliance Responds to 2027 Medicare Advantage Star Ratings Announcement
WASHINGTON — Better Medicare Alliance (BMA) today released the following statement in response to the Centers for Medicare & Medicaid Services’ (CMS) release of the 2027 Medicare Advantage Star Ratings … Continue reading "Better Medicare Alliance Responds to 2027 Medicare Advantage Star Ratings Announcement" The post Better Medicare Alliance Responds to 2027 Medicare Advantage Star Ratings Announcement appeared first on Better Medicare Alliance .
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How can I compare my Medicare coverage options?
You can compare your Medicare coverage options using an online searchable tool on the Medicare.gov website that allows users to compare Medicare coverage options, including Medicare Advantage plans, Medicare Part D plans, and Medigap supplemental policies.
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I have a Medigap policy now, but I want to buy a different one. Can I switch Medigap policies during the Medicare Open Enrollment period?
The annual Medicare Open Enrollment period is designed for enrolling in or switching Medicare Advantage and Part D prescription drug plans, not Medigap policies.
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I’m receiving extra help with my Part D plan premium and cost sharing through the Low-income Subsidy Program. I received a notice that my current plan will no longer be offered next year. Now what do I do?
If you qualify for extra help with your Medicare prescription drug costs, are enrolled in traditional Medicare, and your current prescription drug plan will not be offered next year, you will be automatically reassigned by Medicare to a new prescription drug plan for coverage in the next year.
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I’m having a hard time affording my Medicare Part D drug coverage. Are there any options for me?
You may want to find out if you qualify for extra assistance with your Part D plan premiums and cost sharing, if your income and assets are low enough.
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Humana soars, Alignment plummets in 2027 Medicare Advantage star ratings
A Healthcare Dive analysis of highly anticipated stars data shows a mixed bag of winners and losers, though — as expected — the quality scores slipped overall. See how major carriers fared for 2027.
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CMS: About 71% of MAPD plan enrollees in coverage with four or more stars for 2027
The Trump administration has released the 2027 Medicare Advantage star ratings, with many enrollees in plans that earned at least four stars.
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2027 Medicare Advantage and Part D Star Ratings
2027 Medicare Advantage and Part D Star Ratings Note: The information included in this Fact Sheet is based on the 2027 Medicare Advantage (MA) and Part D Star Ratings published on the Medicare Plan Finder on Oct. 8, 2026. For details on the methodology of the MA and Part D Star Ratings, please refer to the 2027 Part C & D Star Ratings Technical Notes available at http://go.cms.gov/partcanddstarratings .
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Medicare Advantage plans with 5 stars in 2027
Fifteen Medicare Advantage plans earned five-star ratings for 2027, down from 22 last year. CMS released the ratings Oct. 8. Of the 508 contracts that were rated, 188 (37%) earned four stars or higher, compared with about 44% in 2026. The enrollment-weighted average MA star rating was 3.99 this year, compared with 4.01 in 2026, […] The post Medicare Advantage plans with 5 stars in 2027 appeared first on Becker's Payer Issues | Payer News .
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77% of Medicaid improper payments tied to paperwork, not fraud: Report
CMS estimates that 77% of fiscal year 2025 Medicaid improper payments resulted from insufficient documentation rather than fraud or abuse, according to an Oct. 7 report from the Congressional Research Service. The report outlines how federal and state agencies oversee Medicaid program integrity. CRS is a nonpartisan agency within the Library of Congress that prepares […] The post 77% of Medicaid improper payments tied to paperwork, not fraud: Report appeared first on Becker's Payer Issues | P...
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ACHP Urges CMS to Align State Directed Payment Policy With Plans’ Financial Risk
ACHP urges CMS to preserve separate payment terms for state directed payments and coordinate with NAIC so risk-based capital reflects the risk plans bear. Source
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Florida court orders expungement of grand jury report on $10M Centene donation
A Florida appellate court ruled Oct. 7 to expunge a grand jury report regarding a $10 million Centene donation to the Hope Florida Foundation, tied to Florida’s first lady, Casey DeSantis. Florida prosecutors launched a criminal investigation into the donation, which was part of a broader $67 million settlement in 2024 to resolve allegations of […] The post Florida court orders expungement of grand jury report on $10M Centene donation appeared first on Becker's Payer Issues | Payer News .
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Strengthening Medicare Advantage in 2028: ACHP Recommendations to CMS
ACHP urges CMS to simplify risk adjustment, modernize network adequacy and refine Star Ratings in 2028 to protect Medicare Advantage beneficiary choice. Source
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PhRMA launches new legal challenge as CMS brings 'most favored nation' pricing to Medicare Part B
As the Trump administration advances plans to bring its “most favored nation” drug pricing model to Medicare Part B, the pharmaceutical industry’s top lobbying group is pushing back in court.
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Medicare penalizes more hospitals for readmissions
About 80% of hospitals are having their Medicare payments shaved down over high readmission rates this fiscal year, compared with 78% the year prior, according to new CMS data. It continues a worrying trend.
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Opinion: How CMS plans to fix a major flaw in the 340B drug discount program
“A small, well-intended discount for safety net hospitals became a large institutional subsidy with expensive unintended consequences,” writes an HHS leader.
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Clinical Laboratory Improvement Amendments of 1988 (CLIA); Virtual Access, Gynecologic Cytology Proficiency Testing (PT), Personnel Qualifications, and Other Changes
This proposed rule would amend the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to allow for virtual access under the CLIA certificate of the primary testing laboratory that generated the data, with the exception of the subspecialty of cytology, and the use of digital images for gynecologic cytology proficiency testing. This proposed rule also includes proposed changes to personnel qualification requirements and other proposed changes pertaining to SARS-CoV-2 reportin...
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Lawmakers press CMS to roll back proposed restrictions on remote patient monitoring
A bipartisan group of 32 House lawmakers is pressing CMS Administrator Mehmet Oz to reconsider proposed Medicare payment rule changes that would restrict how remote patient monitoring services are staffed and delivered.
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CMS releases list of participants in CJR-X payment model for joint replacement procedures
The Centers for Medicare & Medicaid Services has published its list of participants for its mandatory Comprehensive Care for Joint Replacement Expanded Model, or CJR-X. The payment model focuses on lower extremity joint replacement procedures. CMS is requesting participating hospitals to complete the online primary point of contact form and identify two individuals to serve as their primary points of contact for CJR-X-related communications from the agency. The model, which initially ran in s...
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Rural Health Transformation Program: Early Implementation Actions and Monitoring Plans
What GAO Found The Rural Health Transformation program provides funding for states to conduct rural health activities, such as recruiting clinicians to rural areas and providing training and technology to improve care delivery in rural hospitals. In the latter half of 2025, the Centers for Medicare & Medicaid Services (CMS) completed a number of early key actions to implement the Rural Health Transformation program. These actions included the release of the notice of funding opportunity—which...
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Independence Blue Cross to pay $22.5M in Medicare Advantage inaccurate diagnoses allegations settlement
The settlement resolves allegations from 2017 to 2021 that the company submitted “inaccurate and untruthful” diagnoses data to CMS.
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CMS finalizes updates to price transparency regulations that aim to improve usability
The Trump administration on Monday finalized a rule that aims to make the data files mandated under price transparency regulations more usable.
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FTC sends price transparency warning letters to 24 large hospital systems
Letters sent Monday warn that CMS guidances on price transparency are "a regulatory floor." Hospitals are also subject to the FTC Act's prohibitions on unfair or deceptive marketplace practices, which could apply to incomplete or inaccurate pricing information, the regulator said.
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CMS finalizes price transparency overhaul for payers
The Trump administration is overhauling federal price transparency rules for payers and self-insured employers, including cutting so-called “ghost rates,” expanding out-of-network price disclosures and requiring executives to vouch for the accuracy of the data. The final rule, released Oct. 5 by CMS and the Labor and Treasury departments, revises the price transparency regulations first finalized […] The post CMS finalizes price transparency overhaul for payers appeared first on Becker's Paye...
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CMS flags payment delays, rising costs in No Surprises Act arbitration
CMS is raising concerns about growing costs and payment problems in the federal independent dispute resolution process created by the No Surprises Act and met with every certified independent dispute resolution entity Oct. 1 to talk about possible changes. CMS Administrator Mehmet Oz, MD, Department of Labor Assistant Secretary Daniel Aronowitz, and officials from HHS, […] The post CMS flags payment delays, rising costs in No Surprises Act arbitration appeared first on Becker's Payer Issues |...
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Transparency in Coverage Final Rules (CMS 9882-F)
Transparency in Coverage Final Rules (CMS 9882-F) Introduction
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House Committee Report on Fraud Against Medicare and Medicaid: Oversight Done Wrong
On September 29, exactly five weeks before the mid-term elections, Republicans on the House Energy & Commerce Committee released a Majority Staff Report on fraud against Medicare and Medicaid. The same day the Committee’s Chairman announced a package of 14 bills, 13 of which would amend the Medicaid statute to address fraud against the program. At […]
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Medicare Part D: Payments and Contracts Between Pharmacies and Plan Sponsors That Are Vertically Integrated
What GAO Found The insurance plan sponsors that provide Medicare Part D drug coverage have increasingly become vertically integrated—that is, under common ownership—with pharmacy benefit managers and pharmacies. GAO found that, for four large Part D plan sponsors, the pharmacies they owned accounted for about 24 percent of the Part D drugs they provided to their enrollees (drug utilization) and about 28 percent of the total payments to pharmacies in 2023 (see figure). Payments included both r...
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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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CMS Convenes Certified Independent Dispute Resolution Entity Leaders to Discuss Ways to Improve the Federal Program
CMS Convenes Certified Independent Dispute Resolution Entity Leaders to Discuss Ways to Improve the Federal Program
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Medicare Advantage prescription drug plan options decline for 3rd year in a row: KFF
Medicare Advantage plan choices are shrinking modestly, with the number of MA prescription drug plan options for an average beneficiary dropping for the third year in a row, according to an Oct. 1 KFF analysis of CMS data. The average beneficiary has 28 MA-PD plan choices available for general enrollment in 2027, down from 32 […] The post Medicare Advantage prescription drug plan options decline for 3rd year in a row: KFF appeared first on Becker's Payer Issues | Payer News .
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Sens. King, Curtis Named ACHP’s 2026 Legislative Champions
Sens. Angus King and John Curtis named ACHP's 2026 Legislative Champions for protecting Medicare Advantage Star Ratings quality incentives. Source
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HRSA names 10 drugmakers for revised 340B rebate pilot ahead of 2027 launch
The list of approved participants and drugs is larger than the controversial pilot's first attempted launch. It comes the same day that CMS launched a soon-to-be-mandatory data repository for Part D 340B claim submissions.
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Many Medicare Part D Stand-Alone Drug Plan Enrollees Will See Modest Premium Increases for 2027, But Others Could Pay Much More If They Don’t Switch Plans
This brief analyzes the Medicare Part D stand-alone prescription drug plan (PDP) market for 2027. The analysis shows that there will be a modest reduction in the number of PDPs for 2027, along with modest premium increases less than $10 per month for many enrollees, but much larger monthly premium increases of $50 or more for others if they don’t change plans.
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Independence Blue Cross to pay $22.5M to resolve MA fraud allegations
Independence Blue Cross will pay to settle allegations it defrauded Medicare by inflating diagnosis codes for MA beneficiaries. The payer cited “industry-wide challenges” in applying MA risk adjustment standards.
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Global Benchmark for Efficient Drug Pricing (GLOBE) Model
This final rule implements the Global Benchmark for Efficient Drug Pricing Model (GLOBE Model), a new mandatory Medicare payment model under section 1115A of the Social Security Act. The GLOBE Model will test whether a payment model that uses an alternative method for calculating Medicare Part B drug inflation rebate amounts for certain separately payable Medicare Part B drugs and biological products reduces costs for Original Medicare (OM) beneficiaries and the Medicare program while preserv...
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Preclusion gaps tied to $72M in Medicare Advantage, Part D payments: Report
Vulnerabilities in CMS’ preclusion process contributed to Medicare Advantage and Part D plans making $72 million in payments for services linked to revoked providers from 2022 through 2024, the HHS Office of Inspector General found. Revocation ends a provider’s enrollment in traditional Medicare Parts A and B. The preclusion list bars payment to listed providers […] The post Preclusion gaps tied to $72M in Medicare Advantage, Part D payments: Report appeared first on Becker's Payer Issues | P...
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CMS launches 340B claims data repository
The Centers for Medicare & Medicaid Services’ 340B Part D claims data repository became available Oct. 1 for voluntary data submissions. While data submissions will remain voluntary for now, the agency has proposed making data submissions mandatory starting Jan. 1, 2027. CMS has multiple resources available to support 340B entities and their third-party administrators with data submissions, including a user guide, companion guide, fact sheet and an FAQ.