Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
-
CMS launches outcomes-driven quality measurement initiative for states
The Centers for Medicare & Medicaid Services Sept. 25 announced the launch of a new initiative measuring quality in Medicaid and the Children’s Health Insurance Program. CMS has partnered with 37 states for the Investing in Health Outcomes initiative, where states can commit to a voluntary Medicaid Quality Pledge involving four principles: prioritizing health outcomes over process; streamlining quality measure inventories to reduce burden without sacrificing accountability; advancing digital...
Policy / Regulatory Changes · 140 signals · last 30 days -
37 states partner with CMS on initiative to rethink Medicaid quality measures
The Trump administration announced Friday that it is launching a new partnership with 37 states that aims to rethink how quality is measured in Medicaid and CHIP.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Refocuses Medicaid Quality on Health Outcomes, Launches Innovative Partnership With 37 States
CMS Refocuses Medicaid Quality on Health Outcomes, Launches Innovative Partnership With 37 States The Centers for Medicare & Medicaid Services (CMS) is launching an initiative with a founding group of 37 state partners to focus on how quality is measured in Medicaid and the Children’s Health Insurance Program (CHIP). The effort will put health outcomes — not processes and paperwork — at the center of how success is defined. CMS and its partners will prioritize measures that demonstrate meanin...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS launches Medicaid quality pledge with 37 states
CMS is working with 37 states on quality measurement in Medicaid and the Children’s Health Insurance Program, the agency shared Sept. 25. The initiative, called “Investing in Health Outcomes,” allows states to sign onto a voluntary pledge centered on prioritizing health outcomes over processes, streamlining quality measure inventories, adopting digital quality measurement with near-real-time data […] The post CMS launches Medicaid quality pledge with 37 states appeared first on Becker's Payer...
Policy / Regulatory Changes · 140 signals · last 30 days -
Tennessee received $59M in Medicaid overpayments: OIG
Tennessee’s Medicaid program claimed $59.3 million in federal reimbursement for case management services provided to children who did not qualify for them, the HHS Office of Inspector General said in an audit report published Sept. 23. The OIG’s recommendations are not final decisions, and CMS ultimately determines whether to pursue recovery. Six notes: The post Tennessee received $59M in Medicaid overpayments: OIG appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Privacy Act of 1974; Matching Program
In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), is providing notice of the re-establishment of a matching program between CMS and the Do Not Pay Working System, which is administered by the U.S. Department of the Treasury, Bureau of Fiscal Service (Fiscal Service).
Policy / Regulatory Changes · 140 signals · last 30 days -
AI will inflate healthcare costs before lowering them, Oz says
AI will “turbocharge” medical billing and drive up costs in the short term, CMS Administrator Dr. Mehmet Oz warned Wednesday. But he said the pain is worth it for long-term savings.
Policy / Regulatory Changes · 140 signals · last 30 days -
Private Health Insurance: Federal and State Oversight of Contraceptive Coverage Requirements
What GAO Found In 2024, about 82 percent of women of reproductive age reported using some form of contraception in the past 12 months, according to research from KFF. Most private health plans are generally required to cover the full range of contraceptives for women. The Department of Labor (DOL), the Centers for Medicare & Medicaid Services (CMS)—an agency within the Department of Health and Human Services—and states each have responsibilities for overseeing private health plans, including...
Policy / Regulatory Changes · 140 signals · last 30 days -
Request for Information; Medicare Part D Reasonable and Relevant Pharmacy Contracting Standards
This request for information (RFI) solicits input from interested parties for purposes of establishing standards for reasonable and relevant pharmacy contract terms and conditions under the Medicare prescription drug benefit. Section 6223(a) of the Consolidated Appropriations Act, 2026 (CAA, 2026) amends section 1860D- 4(b)(1)(A) of the Social Security Act (the Act) to require Part D plan sponsors to permit any pharmacy that meets standard contract terms and conditions under the plan to parti...
Policy / Regulatory Changes · 140 signals · last 30 days -
CVS, UnitedHealth, Kaiser challenge proposed Medicare remote monitoring restrictions
Health systems are not the only groups pushing back against a CMS proposal to restrict remote patient monitoring. In July, CMS pitched banning Medicare payments for remote patient monitoring services carried out by third-party companies. As proposed, starting Jan. 1, 2027, payments for remote physiologic and therapeutic monitoring would be permitted only when furnished by […] The post CVS, UnitedHealth, Kaiser challenge proposed Medicare remote monitoring restrictions appeared first on Becker...
UnitedHealthKaiserUnitedHealthcare + Kaiser Permanente · 49 signals · last 30 days -
Humana’s Medicare Part D president exits
TJ Gibb, Humana’s Medicare Part D president, has left the company through its early retirement program. In a Sept. 23 LinkedIn post, Mr. Gibb said he had been with the company for more than two decades, spending the most recent eight years leading Medicare Part D. Mr. Gibb said he is now open to board […] The post Humana’s Medicare Part D president exits appeared first on Becker's Payer Issues | Payer News .
HumanaHumana · 13 signals · last 30 days -
Oz: Medicare Advantage a garden ‘vulnerable to weeds and overgrowth’
The CMS administrator’s comments Tuesday at an event hosted by an MA lobby suggest that the Trump administration remains interested in tougher oversight of the program, despite watering down or scrapping some of its biggest proposed reforms.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS freezes new ACA broker registrations for 2027, culls ‘unauthorized’ enrollees
The agency said the pause would help crack down on fraud among new brokers on the exchanges. It also announced on Tuesday it would cancel the enrollments of more than 760,000 people.
Policy / Regulatory Changes · 140 signals · last 30 days -
MedPAC chair defends Medicare Advantage overpayment analysis at insurer lobby event
Amid growing public debate over how best to analyze spending in MA versus traditional Medicare, Dr. Amol Navathe, the leader of the group behind the most-cited estimate, stepped into the lion’s den to support its work.
Policy / Regulatory Changes · 140 signals · last 30 days -
As CMS overhauls provider tax policy, hospitals plead for minimal administrative burden, uncertainty
Public comment letters from hospital associations asked the administration to stick to the status quo where possible, highlighting changes they said offer no benefit and could lead to unnecessary refunds and recoupments.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS to cancel ACA coverage for 760K, crack down on brokers in latest anti-fraud push
The Trump administration plans to cancel enrollment in Affordable Care Act plans for more than 760,000 people as part of its crackdown on fraud, waste and abuse.
Policy / Regulatory Changes · 140 signals · last 30 days -
American Medical Association urges CMS to stick to 2027 electronic PA deadline, enforcement
The organization also encouraged the agency to call on EHR developers to give implementation timelines, testing opportunities and more.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS cancels ACA policies for 760,000 people, freezes broker registrations
CMS said Sept. 22 that it canceled plan year 2026 ACA policies covering 760,000 people. CMS canceled 315,000 policies covering these individuals Aug. 31. According to federal rulemaking records — set to publish in the Federal Register on Sept. 23 — these people enrolled with agent or broker help but lacked verified citizenship or immigration […] The post CMS cancels ACA policies for 760,000 people, freezes broker registrations appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Federal Marketplace (FFE and SBE-FP) Anti-Fraud Actions
Federal Marketplace (FFE and SBE-FP) Anti-Fraud Actions Introduction Fraud and improper enrollments in the Health Insurance Marketplace ® harm consumers, burden taxpayers, and undermine the integrity of the Federal Marketplace. CMS has identified a pattern of unauthorized enrollments and suspicious agent and broker activity in the Federal Marketplace. In response, the agency has moved aggressively to address these issues through a three-pronged strategy: preventing fraudulent and improper enr...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Cracks Down on Fraud, Waste, and Abuse in the Federal Health Insurance Marketplace®
CMS Cracks Down on Fraud, Waste, and Abuse in the Federal Health Insurance Marketplace ® As part of the ongoing efforts of the White House Task Force to Eliminate Fraud to crush fraud in the healthcare system and protect taxpayer dollars, the Centers for Medicare & Medicaid Services (CMS) is taking aggressive, sweeping actions within the Federal Marketplace — canceling approximately 315,000 unauthorized enrollments covering more than 760,000 individuals, which is expected to result in a retur...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS to remove Marketplace coverage for more than 760,000 as part of anti-fraud efforts
The Centers for Medicare & Medicaid Services will cancel approximately 315,000 enrollments impacting more than 760,000 individuals as part of its anti-fraud, waste and abuse efforts, the agency announced Sept. 22. CMS said it will continue to work with health insurers to identify and investigate potentially unauthorized enrollments, cancel those it determines to be unauthorized, and recoup and end any associated taxpayer subsidies. CMS also released an interim final rule announcing a temporar...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS issues preliminary 2027 clinical laboratory fee schedule rates
The Centers for Medicare & Medicaid Services has released preliminary calendar year 2027 Medicare clinical laboratory fee schedule payment rates. The rates are based on the weighted median of private payer rates for certain clinical diagnostic laboratory test codes. The public has 30 days to review and submit comments to CMS on the preliminary CY 2027 CLFS rates, as the final rates are scheduled to be published in November. The AHA is concerned that the 2027 preliminary rates for laboratory s...
Policy / Regulatory Changes · 140 signals · last 30 days -
Watch live: Vance, Oz to announce crackdown on alleged Obamacare fraud
Vice President Vance and Dr. Mehmet Oz, who leads the Centers for Medicare and Medicaid Services (CMS), are expected to announce a new crackdown Tuesday on alleged fraud in Affordable Care Act insurance exchanges. The administration plans to cancel subsidy payments tied to 760,000 accounts it says are fraudulent, unauthorized or otherwise ineligible, according to...
Policy / Regulatory Changes · 140 signals · last 30 days -
‘A manufactured problem’: AMA pushes for CMS to hold firm on electronic prior auth deadline
The American Medical Association is urging CMS to maintain its Jan. 1, 2027, electronic prior authorization deadline. CMS broadened prior authorization reform efforts — and built upon payers’ existing commitments — to include providers and EHR vendors. Application programming interface requirements are slated to go live in 2027 under the Interoperability and Prior Authorization final […] The post ‘A manufactured problem’: AMA pushes for CMS to hold firm on electronic prior auth deadline appea...
Policy / Regulatory Changes · 140 signals · last 30 days -
Texas hospitals sue Independence Blue Cross over denied claims
Despite a $2.8B settlement over BlueCard program disputes, five HCA-affiliated hospitals say the program still traps them in red tape.
Blue Cross TexasBlue Cross Blue Shield plans · 36 signals · last 30 days