Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
-
Glenmark’s US subsidiary reaches $15.3M settlement with Humana
The U.S. subsidiary of Glenmark Pharmaceuticals will pay Humana nearly $15.3 million in the wake of antitrust and consumer protection lawsuits. Glenmark disclosed the settlement in an Aug. 11 filing with the National Stock Exchange of India. The document said the company faced allegations of price-fixing, market allocation and anticompetitive behavior in more than 35 […] The post Glenmark’s US subsidiary reaches $15.3M settlement with Humana appeared first on Becker's Payer Issues | Payer News .
HumanaHumana · 14 signals · last 30 days -
Almost All Custodial Parents, Caretaker Relatives Should Not be Impacted by Medicaid Work Reporting Requirements in 28 States
As states rush to implement complex new work reporting requirement provisions before January 2027, the new Interim Final Rule (IFR) released by the Centers for Medicare and Medicaid Services (CMS) has caused massive confusion. However, the IFR made important clarifications about which adults are not subject to work reporting requirements (WRRs), are excluded from WRRs, […]
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicaid Program; Prohibition on Federal Medicaid and Children's Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children
This final rule requires that a State Medicaid plan must provide that the Medicaid agency will not make payment under the plan for sex-rejecting procedures for children under 18, and prohibits the use of Federal Medicaid dollars to fund sex-rejecting procedures for individuals under the age of 18. In addition, this final rule requires that a separate State Children's Health Insurance Program (CHIP) plan must provide that the CHIP agency will not make payment under the plan for sex-rejecting p...
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Program; Alternative Payment Model (APM) Incentive Payment Advisory for Clinicians-Request for Current Billing Information for Qualifying APM Participants
This advisory is to alert certain clinicians who are Qualifying Alternative Payment Model (APM) participants (QPs) and eligible to receive an APM Incentive Payment that the Centers for Medicare & Medicaid Services (CMS) does not have the current billing information needed to disburse the payment. This advisory provides information to these clinicians on how to update their billing information to receive this payment for the 2026 payment year.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS finalizes ban on Medicaid, CHIP funding for gender-affirming care provided to children
The Centers for Medicare & Medicaid Services yesterday released a final rule that prohibits states from receiving federal matching funds for “sex-rejecting procedures” for Medicaid beneficiaries under the age of 18, and for Children’s Health Insurance Program beneficiaries in certain states under the age of 19. The final rule does not prevent states from providing coverage for these services with state-only funds. CMS said that federal Medicaid and CHIP funding will be available for a taperin...
Policy / Regulatory Changes · 140 signals · last 30 days -
Oscar flags up to 300K ACA disenrollments tied to CMS fraud crackdown
Oscar Health expects between 250,000 and 300,000 of its marketplace members to be retroactively disenrolled in connection with CMS program integrity initiatives and fraud, waste and abuse enforcement, the insurer disclosed Aug. 7. The expected disenrollments represent roughly 8% to 10% of Oscar’s total membership, which stood at approximately 2.96 million as of June 30. […] The post Oscar flags up to 300K ACA disenrollments tied to CMS fraud crackdown appeared first on Becker's Payer Issues |...
Oscar HealthOscar Health · 2 signals · last 30 days -
CMS requests updated billing information from qualifying alternative payment model participants to disburse payment
The Centers for Medicare & Medicaid Services today released an advisory for certain clinicians who are qualifying alternative payment model participants and eligible to receive APM incentive payments, notifying them that their current billing information must be updated to receive funds for the 2026 payment year. CMS said that it was unable to identify a taxpayer identification number associated with some participants after processing 2026 APM incentive payments and therefore was unable to di...
Policy / Regulatory Changes · 140 signals · last 30 days -
Trump administration cuts Medicaid funding for youth gender-affirming care
CMS Administrator Dr. Mehmet Oz argues the rule will protect children from "irreversible harm." LGBTQ+ advocates say the rule is an attack on transgender youth.
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 -
CMS ends Medicaid, CHIP funding for gender-affirming care for minors
The Trump administration has finalized a rule that would pull funding for gender-affirming care for minors from Medicaid and the Children's Health Insurance Program.
Policy / Regulatory Changes · 140 signals · last 30 days -
Trump administration finalizes rule restricting trans healthcare for minors on Medicaid
The Trump administration on Tuesday released a final rule blocking the use of federal Medicaid dollars for transgender healthcare for minors, as well as barring Children’s Health Insurance Program (CHIP) plans from paying for gender-affirming procedures for minors. The final rule released by The Centers for Medicare and Medicaid Services (CMS) bars Medicaid dollars from...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Ends Federal Medicaid and CHIP Funding for Sex-Rejecting Procedures for Children and Youth
CMS Ends Federal Medicaid and CHIP Funding for Sex-Rejecting Procedures for Children and Youth The Centers for Medicare & Medicaid Services (CMS) is implementing an administration priority consistent with its commitment to protect children from experimental and life-altering sex-rejecting procedures that carry serious long-term health risks and lack sufficiently reliable evidence of clinical benefit. The final rule ends the use of federal Medicaid and CHIP funds to pay for these procedures on...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS' mandatory VBC programs brought substantial administrative costs for hospitals: study
Four mandatory value-based payment programs were associated with more than $3 billion in aggregated administrative costs compared to non-participating hospitals, researchers' analysis of Medicare cost reports found.
Policy / Regulatory Changes · 140 signals · last 30 days -
Texas’ ACA enrollment ‘boom’ didn’t happen after all
Not all CMS data is telling the same story when it comes to ACA enrollment in Texas. As of January, nearly 4.2 million Texans had selected ACA plans for 2026, up from nearly 4 million in 2025. That marked the largest enrollment increase of any state. A previous KFF analysis found Texas had the highest […] The post Texas’ ACA enrollment ‘boom’ didn’t happen after all appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
STAT+: A RAPID proposal for breakthrough coverage, and nurses push back on AI
In this edition of STAT Health Tech: Details from CMS and FDA on the RAPID pathway for breakthrough devices, and nurses push back on AI.
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Program; Regulatory Alignment for Predictable and Immediate Device (RAPID) Coverage Pathway
This notice with comment period provides information to the public on the process CMS will use to provide accelerated Medicare coverage through the Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway for new innovative technologies. The RAPID coverage pathway leverages existing processes to provide expedited national Medicare coverage for eligible technologies. This notice with comment period solicits public comment on the proposed RAPID coverage pathway.
Policy / Regulatory Changes · 140 signals · last 30 days -
Arkansas requests 2-year extension of Medicaid expansion waiver
Arkansas is seeking CMS’ approval of a two-year extension for the Section 1115 waiver enabling the state’s Medicaid expansion program, Arkansas Health and Opportunity for Me. Arkansas Department of Human Services Secretary Janet Mann sent CMS a letter Aug. 5 detailing the request. The letter follows CMS’ denial of the waiver’s renewal past 2026, affecting […] The post Arkansas requests 2-year extension of Medicaid expansion waiver appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in the State of Washington
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in the State of Washington The Centers for Medicare & Medicaid Services (CMS) announced today additional resources and flexibility available in response to a Public Health Emergency (PHE) in Washington state due to emergency conditions resulting from major wildfires, including the Fairview, Autumn Lane, and Old Trails fires near Spokane County beginning Aug.1, 2026, and continuing. CMS is working closely with Washin...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS lifts enrollment suspension on Maryland Medicare Advantage plan
CMS has lifted the enrollment suspension it imposed on Provider Partners Health Plans’ Maryland I-SNP after the insurer corrected network deficiencies. The agency suspended enrollment into the plan in late May after Provider Partners’ lost all contracted long-term care facilities in its network and then disenrolled 29 members from the program without their consent. In […] The post CMS lifts enrollment suspension on Maryland Medicare Advantage plan appeared first on Becker's Payer Issues | Pay...
Policy / Regulatory Changes · 140 signals · last 30 days -
Regulatory Alignment for Predictable and Immediate Device Coverage Pathway (CMS-3487-NC) Procedural Notice Inviting Comment
Regulatory Alignment for Predictable and Immediate Device Coverage Pathway (CMS-3487-NC) Procedural Notice Inviting Comment
Policy / Regulatory Changes · 140 signals · last 30 days -
Dr. Oz urges senators to reject Budd hemp amendment
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS), is urging senators to not support an amendment that would allow a federal ban on most hemp-derived products to take effect in November. In a Friday letter, Oz noted he had “grave concerns” about the amendment from Sen. Ted Budd (R-N.C.),...
Policy / Regulatory Changes · 140 signals · last 30 days -
Anthem BCBS Indiana’s ortho network is saving employers $15,000 per case
It has been about eight months since Anthem Blue Cross and Blue Shield in Indiana kicked off its HealthSync Designated Orthopedic Network, directing Anthem HealthSync plan members to surgeons and facilities that satisfy certain cost and quality benchmarks. Now, savings are rolling in. In an upcoming episode of the “Becker’s Payer Issues Podcast,” Jessica Lopez-Liggett, […] The post Anthem BCBS Indiana’s ortho network is saving employers $15,000 per case appeared first on Becker's Payer Issues...
Elevance Health + Blue Cross Blue Shield plans · 48 signals · last 30 days -
CMS releases notice on pathway for expediting access to certain medical devices for Medicare beneficiaries
The Centers for Medicare & Medicaid Services Aug. 7 released a procedural notice on its new pathway to expedite access to certain Food and Drug Administration-designated Class II and Class III devices for Medicare beneficiaries. The Regulatory Alignment for Predictable and Immediate Device coverage pathway, or RAPID, is designed to reduce delays between FDA market authorization and Medicare national coverage determinations. CMS is accepting comments on the procedural notice for 60 days follow...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS releases implementation timeline guidance for updates to No Surprises Act independent dispute resolution process
Guidance on the implementation timeline for the No Surprises Act independent dispute resolution operations final rule was released Aug. 7 by the Departments of Labor, Health and Human Services, and the Treasury, along with the Office of Personnel Management. The final rule, issued May 28, was designed to streamline communication between group health plans and health insurance issuers, providers and certified IDR entities, while clarifying timelines and processes. The guidance includes details...
Policy / Regulatory Changes · 140 signals · last 30 days -
On the heels of star rating win, Clover Health boosts outlook on strength of MA membership growth in Q2
The company posted $153 million in profit, up 54% year-over-year, according to financial results published Wednesday afternoon.
Clover HealthClover Health · 2 signals · last 30 days