Policy / Regulatory Changes
Signals classified into this topic vertical.
235 signals
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AHA urges CMS to prioritize hospitals, providers with Rural Health Transformation Program funding
The AHA Aug. 5 provided comments to the Centers for Medicare & Medicaid Services on the distribution of funding for the Rural Health Transformation Program. The program will fund $50 billion to rural providers from fiscal year 2026 to FY 2030. The AHA urged CMS to prioritize direct support for rural hospitals and providers, specifically by lifting a 15% funding cap it imposed on provider payments and a 20% cap imposed on infrastructure and capital improvement funding for years two through fiv...
Policy / Regulatory Changes · 67 signals · last 30 days -
Payers ranked by digital experience|2026
In 2026, Aetna offers the best digital experience among major insurers on both desktop and mobile, according to new research from Corporate Insight shared with Becker’s. Corporate Insight’s “2026 Commercial Health Plan Experience Benchmark,” published Aug. 5, evaluated 24 commercial payers across more than 240 desktop and mobile functions. The report identifies overall health plan […] The post Payers ranked by digital experience|2026 appeared first on Becker's Payer Issues | Payer News .
AetnaCVS Health / Aetna · 10 signals · last 30 days -
Medicare Advantage provider to pay $14.1M to settle false diagnosis code allegations
Jacksonville, Fla.-based management services organization Complete Health Partners Holdings has agreed to pay $14.1 million to settle allegations that it violated the False Claims Act by causing false diagnosis codes to be submitted to boost Medicare Advantage payments. The settlement resolves allegations that between 2020 and 2023, Complete Health submitted diagnosis codes under Hierarchical Condition […] The post Medicare Advantage provider to pay $14.1M to settle false diagnosis code alleg...
Policy / Regulatory Changes · 67 signals · last 30 days -
Complete Health to pay $14M to settle Medicare Advantage fraud allegations
The value-based primary care provider submitted false diagnosis codes to the CMS for three years, inflating its reimbursement by millions of dollars, according to the DOJ.
Policy / Regulatory Changes · 67 signals · last 30 days -
Privacy Act of 1974; Matching Program
In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of the re-establishment of a matching program between CMS and the Department of War for "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act through a Department of War Health Benefits Plan."
Policy / Regulatory Changes · 67 signals · last 30 days -
Amid spending growth scrutiny, CMS unveils toolkit for states to safeguard autism care
The toolkit does not establish new federal requirements or endorse any single treatment approach to applied behavior analysis (ABA). Instead, CMS says it gives states practical tools to ensure every child gets individualized, evidence-based care.
Policy / Regulatory Changes · 67 signals · last 30 days -
Clover Insurance Company v. Department of Health and Human Services et al.
Medicare Advantage Star Ratings litigation. The post Clover Insurance Company v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .
Policy / Regulatory Changes · 67 signals · last 30 days -
Complete Health to pay $14.1M in Medicare Advantage coding misuse allegations settlement
The settlement resolves allegations from 2020 to 2023 that the company submitted HCCs that were "not clinically valid" or not supported by medical records or treatment plans.
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS decision leaves Arkansas’ Medicaid expansion program in jeopardy
CMS verbally confirmed its denial of the waiver enabling Arkansas’ Medicaid expansion program, the Arkansas Health and Opportunity for Me program, leaving more than 200,000 residents in limbo. Republican Gov. Sarah Huckabee Sanders’ office confirmed the update to Becker’s Aug. 4. The governor is expecting a formal notice in writing shortly. A spokesperson for the […] The post CMS decision leaves Arkansas’ Medicaid expansion program in jeopardy appeared first on Becker's Payer Issues | Payer N...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS Launches New State Toolkit to Protect Children with Autism, Strengthen Oversight of Applied Behavior Analysis Services
CMS Launches New State Toolkit to Protect Children with Autism, Strengthen Oversight of Applied Behavior Analysis Services Resource supports child-centered, evidence-based care while strengthening program integrity, protecting children from inappropriate treatment, and safeguarding Medicaid and Children’s Health Insurance Program (CHIP) resources
Policy / Regulatory Changes · 67 signals · last 30 days -
STAT+: Are AI scribes medical devices? UK regulator weighs in.
In this edition of STAT Health Tech: UK regulator on AI scribes, CMS eliminates key payment pathways for 'breakthrough' devices, and more.
Policy / Regulatory Changes · 67 signals · last 30 days -
What the latest Star Ratings turmoil says about the program
The Medicare Advantage Star Ratings program is rife with drama.
Policy / Regulatory Changes · 67 signals · last 30 days -
Healthcare Advisory Committee (HAC); Announcement of the HAC Meetings for Fiscal Year 2026-2027
This meeting notice announces the virtual meeting public components of the Healthcare Advisory Committee (HAC or Committee) for the fiscal year 2026-2027. The purpose of the Committee is to advise the Secretary of HHS and the CMS Administrator on programs and policies that can improve the United States healthcare system consistent with the Executive Order Establishing the President's Make American Healthy Again Commission. The virtual meetings are open to the public.
Policy / Regulatory Changes · 67 signals · last 30 days -
EmblemHealth, NYC reach $53M copay settlement with Medicare retirees
EmblemHealth and New York City have agreed to settle a class action over $15 copays the city imposed on Medicare-eligible retirees enrolled in its GHI Senior Care plan. The proposed settlement, filed July 30, caps the defendants’ liability at $53 million and locks in the copays at $15 through 2027. Five retirees and the NYC […] The post EmblemHealth, NYC reach $53M copay settlement with Medicare retirees appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
Readout: CMS Celebrates Delivery of the Health Technology Ecosystem, One Year After Launch
Readout: CMS Celebrates Delivery of the Health Technology Ecosystem, One Year After Launch The Centers for Medicare & Medicaid Services (CMS) recently hosted the one-year celebration of the Health Technology Ecosystem, bringing together leaders from the government, healthcare, and technology sectors to feature the significant progress made over the past year in advancing interoperability, improving health data sharing, and expanding patient access to digital health tools.
Policy / Regulatory Changes · 67 signals · last 30 days -
22 states sue to block 2027 ACA marketplace rule
A coalition of 22 states are suing to block key pieces of CMS’ 2027 ACA marketplace rule, arguing the changes will push consumers into “barebones” coverage and revive provisions a federal court previously struck down. The complaint, filed July 31 in the U.S. District Court for the Northern District of California, is being co-led by […] The post 22 states sue to block 2027 ACA marketplace rule appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
The next phase of value-based care: policy, technology and what comes next
Value-based care continues to evolve as healthcare organizations balance new policy priorities, growing technology capabilities and the realities of delivering coordinated, patient-centered care. In this episode of Healthcare Insider, host Shannon Mortland sits down with Dan Brillman, deputy administrator at the Centers for Medicare & Medicaid Services (CMS) and director of the Center for Medicaid & CHIP Services (CMCS), and Dr. Rob Bessler, CEO of Honest Health, for a timely discussion on wh...
Policy / Regulatory Changes · 67 signals · last 30 days -
Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
This final rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2027. This final rule also includes an analysis of Medicare non-hospice spending, including details regarding a hospice service and spending variation index, and finalizes the requirement that hospices provide the hospice election statement addendum to all Medicare beneficiaries at the time of hospice election. Additionally, this rule finalizes conforming changes to discharge from hospice c...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS News: CMS Announces Nationwide Expansion of Proven Joint Replacement Program
CMS Announces Nationwide Expansion of Proven Joint Replacement Program The Centers for Medicare & Medicaid Services (CMS) is expanding an initiative to improve care coordination for hip, knee, and ankle replacements, ensuring providers work together from pre-surgery education through post-op recovery to promote a seamless patient care experience and optimal health outcomes. Beginning in January 2028, most hospitals will be required to participate in the Comprehensive Care for Joint Replacemen...
Policy / Regulatory Changes · 67 signals · last 30 days -
FY 2027 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule (CMS-1849-F)
FY 2027 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule (CMS-1849-F)
Policy / Regulatory Changes · 67 signals · last 30 days -
5 insurers stepping back from Medicare Advantage
In recent years, a handful of insurers have left the Medicare Advantage market, and others have scaled back. Medical costs and federal cost-containment efforts have affected MA’s financial viability. For example, ongoing tensions around how star ratings are calculated — and, thus, which plans secure bonus payments — have complicated matters. Amid prior authorization denials […] The post 5 insurers stepping back from Medicare Advantage appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
AHA requests CMS reconsider provisions within Medicaid community engagement rule
The AHA July 31 provided comments to the Centers for Medicare & Medicaid Services on its interim final rule on Medicaid community engagement requirements. To be eligible for or maintain Medicaid coverage, the rule requires certain adults to complete 80 hours per month of “qualifying activities,” such as employment, education, community service or participation in a work program, or meet equivalent income thresholds. The AHA shared concerns about two provisions that it said could increase proc...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS releases FY 2027 final rule for long-term care hospitals
The Centers for Medicare & Medicaid Services today finalized a 2.3% payment update for long-term care hospitals for fiscal year 2027 relative to FY 2026. This includes a 3.2% market basket update, reduced by a 0.9 percentage point productivity adjustment. In addition, CMS finalized its decision to freeze the outlier threshold at $78,936, the same level as FY 2026. For the LTCH Quality Reporting Program, CMS finalized the removal of two measures related to COVID-19 vaccination and a shortened...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS issues hospital inpatient payment final rule for FY 2027
The Centers for Medicare & Medicaid Services today issued a final rule that would increase Medicare rates by a net 2.3% in fiscal year 2027, compared with FY 2026, for hospitals that are meaningful users of electronic health records and submit quality measure data. This payment update reflects a 3.2% hospital market basket increase, as well as a 0.9% productivity cut. Overall, it will increase hospital payments by $2.9 billion in FY 2027 compared to FY 2026. This includes an increase in dispr...
Policy / Regulatory Changes · 67 signals · last 30 days -
Op-ed: Hospitals on the edge, a time for CMS to do no harm
The Centers for Medicare & Medicaid Services' job is to implement last year's $911 billion Medicaid spending reduction, not cut even deeper than Congress intended, New Jersey Hospital Association President and CEO Cathy Bennett writes.
Policy / Regulatory Changes · 67 signals · last 30 days