Policy / Regulatory Changes
Signals classified into this topic vertical.
440 signals
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CMS proposed rule lays groundwork for more OBBBA provider tax cutbacks
The agency took another step toward codifying and enacting provider tax thresholds outlined in last summer's One Big Beautiful Bill Act.
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS appeals court decision behind 2026 MA star ratings recalculations
The Trump administration will appeal a Georgia court ruling that led it to broadly recalculate insurers' Medicare Advantage star ratings scores for 2026.
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS appeals decision requiring Clover Health star ratings redo
The Centers for Medicare and Medicaid Services last month increased Clover Health's Medicare Advantage quality scores.
Clover HealthClover Health · 2 signals · last 30 days -
CMS proposes new provider tax class for payers in $246B Medicaid overhaul: 8 things to know
CMS on July 21 proposed sweeping changes to Medicaid provider tax policy that would replace the longstanding 6% federal threshold with state- and provider-specific limits, phase down allowable taxes in Medicaid expansion states, create a new provider tax class for payers and strengthen federal oversight of a financing mechanism used by nearly every state. The […] The post CMS proposes new provider tax class for payers in $246B Medicaid overhaul: 8 things to know appeared first on Becker's Pay...
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS moves to codify limits on Medicaid provider taxes
The new proposed rule is meant to prevent states from guaranteeing providers will be refunded for their taxes, and should save Washington $246 billion over the next decade, regulators said.
Policy / Regulatory Changes · 142 signals · last 30 days -
Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes Proposed Rule (CMS-2452-P)
Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes Proposed Rule (CMS-2452-P)
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS proposes more restrictions on provider taxes that fund Medicaid
The Centers for Medicare and Medicaid Services proposed a regulation that would limit a key Medicaid financing tool.
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS withholds $1B in Medicaid payments from California, Minnesota
The government is pausing the payments due to what federal officials called "suspected fraud and noncompliance."
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS issues proposed provider tax rule
The Centers for Medicare & Medicaid Services today released a proposed rule that would update Medicaid provider tax policies included in the July 2025 reconciliation law and change how the agency determines whether certain healthcare taxes comply with federal requirements. States commonly use provider taxes to help finance Medicaid. CMS said the proposed changes are intended to ensure those taxes are not structured in a way that effectively guarantees providers receive their tax payments back...
Policy / Regulatory Changes · 142 signals · last 30 days -
AHA comments to CMS on proposed rule covering Medicaid supplemental payments
The AHA provided comments July 21 to the Centers for Medicare & Medicaid Services on its proposed rule to modify policies governing Medicaid state-directed payments as authorized under the July 2025 reconciliation bill. The rule also includes proposals that are beyond what the statute requires, such as new limits on certain targeted fee-for-service payments and other SDP service types, as well as new limitations on SDP design. The AHA said that CMS’ projection of a $510.1 billion reduction in...
Policy / Regulatory Changes · 142 signals · last 30 days -
HHS defers $1B+ in Medicaid funds to Minnesota, California
HHS and CMS are deferring more than $1 billion in federal Medicaid funds to Minnesota and California, agency officials confirmed July 21. The agencies said they are deferring approximately $867.5 million in payments to California and $199 million to Minnesota after financial reviews flagged claims that require additional assessment before the release of matching funds. […] The post HHS defers $1B+ in Medicaid funds to Minnesota, California appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 142 signals · last 30 days -
CCF Comments on State Directed Payments NPRM
The Georgetown University Center for Children and Families submitted the following comments to the Center for Medicare and Medicaid (CMS) and the U.S. Department of Health and Human Services (DHHS) regarding Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments. Read the Comments
Policy / Regulatory Changes · 142 signals · last 30 days -
Program Integrity: Actions Needed to Reduce Improper Payment and Fraud Risks in VA Community Care and Medicare Advantage
What GAO Found The Office of Management and Budget annually designates a list of programs considered high-priority for improper payments. The Department of Veterans Affairs (VA) Community Care program and the Centers for Medicare & Medicaid Services’ (CMS) Medicare Advantage program are two of the 30 programs designated as high priority for fiscal year 2025. VA reported a Community Care improper payment estimate of $608 million for fiscal year 2025, or 2.4 percent of the program’s outlays. CM...
Policy / Regulatory Changes · 142 signals · last 30 days -
Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
This document corrects typographical errors in the final rule that appeared in the May 20, 2026, Federal Register titled "Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program."
Policy / Regulatory Changes · 142 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 · 142 signals · last 30 days -
District court pauses 8 provisions from 2027 notice of benefit and payment parameters final rule
The U.S. District Court for the District of Maryland July 16 enjoined eight provisions from the Centers for Medicare & Medicaid Services’ 2027 notice of benefit and payment parameters final rule, which were set to become effective July 20. The final rule issues standards for qualified health plans offered through the health insurance marketplaces. The injunction pauses multiple policies that the AHA previously raised concerns about, including an expansion of annual out-of-pocket maximums for...
Policy / Regulatory Changes · 142 signals · last 30 days -
Judge pauses ACA catastrophic plan expansion, 7 other provisions
A federal judge has paused eight provisions of CMS’ 2027 ACA marketplace rule, blocking a slate of eligibility, verification and plan design changes just days before they were set to take effect July 20. Judge Brendan Hurson of the U.S. District Court for the District of Maryland granted the stay July 16 in City of […] The post Judge pauses ACA catastrophic plan expansion, 7 other provisions appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 142 signals · last 30 days -
Why CMS’ Shared Savings proposals matter for ACO growth
The Centers for Medicare and Medicaid Services is eager to attract more physicians to value-based care initiatives such as the Medicare Shared Savings Program.
Policy / Regulatory Changes · 142 signals · last 30 days -
How Medicare Advantage plans can strengthen Star Ratings through better care transitions
Why leading Medicare Advantage plans are making care transitions a strategic priority.
Policy / Regulatory Changes · 142 signals · last 30 days -
Medicare Program; Inflation Reduction Act of 2022 (IRA) Medicare Drug Price Negotiation Program Draft Guidance; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' draft guidance for the Medicare Drug Price Negotiation Program regarding manufacturer effectuation of the maximum fair price in 2028 for the implementation of the Inflation Reduction Act of 2022 (IRA) (Pub. L. 117-169). CMS' draft guidance and other IRA-related guidance can be viewed on the CMS website at https://www.cms.gov/priorities/medicare- prescription-drug-affordability/med...
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS proposes major Medicare reforms to shift physician pay, phase out MIPS and expand ACO participation
The Trump administration is proposing sweeping changes to Medicare payment and value-based care programs it says will expand accountable care, modernize physician payment and help shift the healthcare system toward prevention instead of treatment.
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS seeks public feedback on 'AMA's monopoly' over CPT codes
The agency joins prominent Republican lawmakers in scrutinizing the government's decades-long reliance on the physician association's proprietary coding system, and said it believes a divorce would not run afoul of statute.
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS proposal to block third-party vendors will upend remote monitoring services, health tech leaders say
Tucked inside a Medicare physician pay draft rule released this week, federal regulators proposed major changes to remote patient monitoring payment policies that experts say will significantly disrupt providers' RPM programs.
Policy / Regulatory Changes · 142 signals · last 30 days -
Senate strikes down Dems move to overturn CMS’ WISeR AI prior auth pilot
Democratic lawmakers in the Senate and House of Representatives introduced resolutions back in May to stop the WISeR model that introduces AI-driven prior authorization to traditional Medicare.
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS Launches Medicare GLP-1 Bridge, Expanding Access to GLP-1 Medications
CMS Launches Medicare GLP-1 Bridge, Expanding Access to GLP-1 Medications Eligible Medicare beneficiaries may now get certain GLP-1 medications for $50 per month through the Medicare GLP-1 Bridge, a new Centers for Medicare & Medicaid Services (CMS) initiative designed to expand access to innovative treatments and test the impacts of increased access to GLP-1 drugs for weight management on the Medicare program.
Policy / Regulatory Changes · 142 signals · last 30 days