Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Blue CrossBlue Cross Blue Shield plans · 36 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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 |...
Policy / Regulatory Changes · 140 signals · last 30 days -
Transparency in Coverage Final Rules (CMS 9882-F)
Transparency in Coverage Final Rules (CMS 9882-F) Introduction
Policy / Regulatory Changes · 140 signals · last 30 days -
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 […]
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
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 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
Policy / Regulatory Changes · 140 signals · last 30 days -
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 .
Policy / Regulatory Changes · 140 signals · last 30 days -
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
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Blue CrossBlue Cross Blue Shield plans · 36 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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...
Policy / Regulatory Changes · 140 signals · last 30 days -
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.
Policy / Regulatory Changes · 140 signals · last 30 days