Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
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 -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
KaiserKaiser Permanente · 4 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
CVS HealthCVS Health / Aetna · 12 signals · last 30 days -
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 HealthCVS Health / Aetna · 12 signals · last 30 days