Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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Elevance Health to pay $15M to settle nurse overtime lawsuits
A federal judge has given final approval to a $14.75 million settlement between Elevance Health and a group of nurses who alleged the insurer misclassified them as exempt from overtime pay. U.S. District Judge David Novak signed off on the deal Aug. 20 in the Eastern District of Virginia, closing out five related lawsuits that […] The post Elevance Health to pay $15M to settle nurse overtime lawsuits appeared first on Becker's Payer Issues | Payer News .
Elevance VirginiaElevance Health · 16 signals · last 30 days -
Medicare Advantage provider agrees to $2.4M false claims settlement
Tennessee-based in-home care provider Monogram Health has agreed to pay $2.4 million to settle allegations that it caused the submission of false diagnosis codes to boost Medicare Advantage payments. From Jan. 1, 2021, through Dec. 31, 2023, Monogram allegedly knowingly submitted diagnosis codes that were not clinically accurate, not supported by patients’ medical records, or […] The post Medicare Advantage provider agrees to $2.4M false claims settlement appeared first on Becker's Payer Issu...
Policy / Regulatory Changes · 140 signals · last 30 days -
Oregon to launch state-based ACA exchange
Oregon has received approval from CMS to launch a state-run ACA marketplace starting Nov. 1. The new platform, Explore Health, will let Oregon residents shop for ACA plans, check subsidy eligibility and enroll in coverage directly through the state rather than the federal exchange. The Oregon legislature authorized the transition in 2023 through Senate Bill […] The post Oregon to launch state-based ACA exchange appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Oz says MMR vaccine 'is not a lethal vaccine'
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS), noted Sunday the measles, mumps and rubella (MMR) vaccine is not lethal, contradicting President Trump. “The MMR vaccine is not a lethal vaccine, and it is offered in other countries,” Oz told host Margaret Brennan on CBS News’s “Face the Nation.”...
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
Senate Democrats call on feds to halt Medicaid data sharing with ICE
Senate Democrats on Aug. 17 called on federal officials to end Medicaid enrollee data sharing with the Department of Homeland Security and Immigration and Customs Enforcement. Sens. Ron Wyden, D-Ore., Jeff Merkley, D-Ore., Edward Markey, D-Mass., Cory Booker, D-N.J., and Chris Van Hollen, D-Md., sent two letters, one to CMS and HHS and another to […] The post Senate Democrats call on feds to halt Medicaid data sharing with ICE appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Privacy Act of 1974; System of Records
In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS) is establishing a new system of records to be maintained by the Centers for Medicare & Medicaid Services (CMS), titled "Nurses for Nursing Homes Program (NNHP)," system No. 09-70-0545. The new system of records will cover the collection of records on individuals who apply for, participate in, or otherwise support the Nurses for Nursing Homes Program (NNHP). Records maintained in the syste...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS News: Trump Administration Announces $35 million to Support Investments in Rapid Response Capabilities to Improve Rural Pennsylvania Healthcare
Trump Administration Announces $35 million to Support Investments in Rapid Response Capabilities to Improve Rural Pennsylvania Healthcare Federal investment will help provide technology, equipment and expanded transportation options for communities across Pennsylvania The Trump Administration announced that $35 million, made possible through the federal Rural Health Transformation Program (RHTP), is being put to work to improve health outcomes among rural Pennsylvanians by updating to new, mo...
Policy / Regulatory Changes · 140 signals · last 30 days -
‘No-brainer’: PBMs commit to posting TrumpRx price comparisons
The Pharmaceutical Care Management Association and its members committed to sharing TrumpRx’s cash prices for drugs through their real-time benefit tools and other cost transparency platforms. An Aug. 13 news release said the association coordinated with the Trump administration and CMS Administrator Mehmet Oz, MD, on the effort. PCMA members include Elevance Health’s CarelonRx, CVS […] The post ‘No-brainer’: PBMs commit to posting TrumpRx price comparisons appeared first on Becker's Payer Is...
ElevanceElevance Health · 16 signals · last 30 days -
AMA applauds updated CMS prior authorization reporting guidance
The organization said the agency responded to its concerns about payers' implementation of the transparency provisions of the 2024 final rule.
Policy / Regulatory Changes · 140 signals · last 30 days -
CommonSpirit’s 5 targets for judging payer prior auth reform — and its Humana milestone
In 2025, insurers committed to scaling back and simplifying prior authorization as they fall into line with standards established by the 2024 Interoperability and Prior Authorization and Medicare Advantage final rules. But recent aggregated data on prior authorization — which insurers now have to report, thanks to the 2024 regulation — lacks relevant context. For […] The post CommonSpirit’s 5 targets for judging payer prior auth reform — and its Humana milestone appeared first on Becker's Pay...
HumanaHumana · 14 signals · last 30 days -
CMS announces QualTech event focusing on innovative technology to improve health outcomes
The Centers for Medicare & Medicaid Services yesterday announced the launch of QualTech, a new event created to identify innovative technology that improves health outcomes. CMS is seeking participants from U.S-based teams, academic institutions, nonprofit organizations, private sector companies, industry associations and other stakeholders to propose technology solutions in advance of the event. Applicants must align proposal submissions to one of four priority opportunity areas: using artif...
Policy / Regulatory Changes · 140 signals · last 30 days -
America digitized healthcare. Now it’s time to connect it.
Seema Verma, a former administrator for the CMS, makes the case for better connecting healthcare data as the agency marks the first anniversary of its “Kill the Clipboard” initiative.
Policy / Regulatory Changes · 140 signals · last 30 days -
Medi-Cal plans brace for ‘devastating’ asset limit crunch
California’s Medicaid program, Medi-Cal, is slashing asset limits 84% in July 2027. As a result, Medi-Cal members risk losing eligibility — and insurers are feeling the pressure. In 2022, California lifted the asset limit from $2,000 to $130,000 for individuals. CMS eventually approved a state proposal to drop the asset test, but California resurfaced the […] The post Medi-Cal plans brace for ‘devastating’ asset limit crunch appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
AHA comments on CMS proposal to codify Medicare Drug Price Negotiation Program regulations
The AHA Aug. 17 provided comments to the Centers for Medicare & Medicaid Services on its proposed rule to codify in regulation the Medicare Drug Price Negotiation Program. The AHA recommended CMS require drug manufacturers to make the maximum fair price available through a point-of-sale mechanism and eliminate any option permitting manufacturers to meet their obligations through retrospective rebates or post-sale reconciliations. The AHA expressed concerns that permitting retrospective MFP ef...
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Advantage has always demanded accuracy. What’s changed is the level of scrutiny.
The Medicare Advantage (MA) landscape is entering a new chapter. For the first 25 years of the program, success was largely measured by how effectively organizations captured and supported HCCs while maintaining coding accuracy. That objective hasn’t changed. What has changed is the scorecard. As CMS expands RADV across all Medicare Advantage contracts, implements CMS-HCC […] The post Medicare Advantage has always demanded accuracy. What’s changed is the level of scrutiny. appeared first on B...
Policy / Regulatory Changes · 140 signals · last 30 days -
Why the first 24 hours after discharge matter for star ratings
Why leading Medicare Advantage plans are rethinking care transitions.
Policy / Regulatory Changes · 140 signals · last 30 days -
Why CMS’ Medicaid waiver pullback matters to providers
CMS risks raising costs for states, weakening provider finances and limiting Medicaid innovation as it curbs 1115 waivers.
Policy / Regulatory Changes · 140 signals · last 30 days -
Industry Voices—AI should help cancer patients survive the healthcare system
Cancer care navigators are an invaluable resource, but there are nowhere near enough navigators to meet the scale of the need. This is where AI can make a meaningful difference, write the Digital Medicine Society's Jennifer Goldsack and former CMS Chief Medical Officer Lee Fleisher, M.D.
Policy / Regulatory Changes · 140 signals · last 30 days -
Hippocratic AI rolls out platform to coordinate teams of conversational voice AI agents
For health plans, the AI teams support functions such as member onboarding, chronic care management and Star Ratings improvement. Provider-focused offerings target patient onboarding, care gap closure and inpatient and ambulatory workflows.
Policy / Regulatory Changes · 140 signals · last 30 days -
‘Private option’ Medicaid expansion under threat from CMS
Arkansas Medicaid coverage for hundreds of thousands is uncertain next year after the Trump administration denied a key waiver renewal.
Policy / Regulatory Changes · 140 signals · last 30 days -
Prior authorization denials vary widely among insurers, first-of-its-kind data shows
Denials ranged from 2% to 25% among insurers last year, according to a KFF analysis of new prior authorization data that the CMS forced insurers to release.
Policy / Regulatory Changes · 140 signals · last 30 days -
How will legal challenges fare against CMS rule on gender-affirming care?
A CMS rule finalized this week may prove more difficult to challenge than previous Trump administration actions to end transgender care for young people.
Policy / Regulatory Changes · 140 signals · last 30 days -
Where prior authorization stands — and where data still falls short
Prior authorization data is now public — but it is not giving much to work with. CMS’ Interoperability and Prior Authorization Final Rule from 2024 focused on easing prior authorization across government-affiliated healthcare programs. Involved payers now have to report certain aggregated metrics, such as approval and denial rates. Data covering 2025 went live March […] The post Where prior authorization stands — and where data still falls short appeared first on Becker's Payer Issues | Payer...
Policy / Regulatory Changes · 140 signals · last 30 days -
Payers ranked by prior authorization denial rates
Health insurers denied between 12% and 18% of standard prior authorization requests across Medicare Advantage, Medicaid managed care and ACA marketplace plans in 2025, with wide variation among the largest payers, according to a KFF analysis published Aug. 13. CMS previously finalized a rule requiring certain insurers to publicly report prior auth metrics, including denial […] The post Payers ranked by prior authorization denial rates appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days