Policy / Regulatory Changes
Signals classified into this topic vertical.
235 signals
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Blog explains what hospitals need to know on electronic prior authorization requirements
An AHA blog published July 28 highlights new electronic prior authorization requirements that begin Jan. 1, 2027, as a result of the Centers for Medicare & Medicaid Services’ 2024 Interoperability and Prior Authorization final rule. The blog explains why transitioning to the new process will be a significant operational change that will include coordination with health plans, electronic health record vendors and other technology partners. READ MORE
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS releases 2025 report on program audits, enforcement for Medicare Advantage, Part D
The Centers for Medicare & Medicaid Services July 27 released its Contract Year 2025 Part C and Part D Program Audit and Enforcement Report, outlining key compliance issues identified through Medicare Advantage and Part D audits and enforcement activities. CMS emphasized recurring problems involving prior authorization and appeals processing, beneficiary access to medications and services, care coordination, enrollment and eligibility errors, and oversight of delegated entities. The report al...
Policy / Regulatory Changes · 67 signals · last 30 days -
STAT+: Three questions with Whoop’s new CMO
In this edition of STAT Health Tech: A chat with Whoop's new chief medical officer, an update on CMS health tech initiative, and more.
Policy / Regulatory Changes · 67 signals · last 30 days -
STAT+: CMS evaluates one year of health tech progress, announces eight new pledge categories
One year after launching the CMS Health Tech Ecosystem, officials convened in D.C. to celebrate the Trump administration modernizing health technology.
Policy / Regulatory Changes · 67 signals · last 30 days -
4 more Medicare Advantage contracts get 5 stars in revised ratings
Four more Medicare Advantage prescription drug plans have received five-star ratings thanks to CMS’ recalculation. CMS initially unveiled 2026 MA star ratings in October, with 18 MA-PD contracts scoring five stars overall. On July 22, CMS released updated 2026 Medicare Advantage star ratings. The recalculation comes in the fallout of Clover Health’s lawsuit challenging the […] The post 4 more Medicare Advantage contracts get 5 stars in revised ratings appeared first on Becker's Payer Issues |...
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CMS Issues New Rule Again Going Beyond H.R. 1 Requirements to Further Restrict State Use of Medicaid Provider Taxes
On July 21, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a new proposed rule that would implement two of H.R. 1’s restrictions on states’ use of provider taxes to finance their share of Medicaid costs. H.R. 1 included three provider tax restrictions: (1) a prohibition on new provider taxes and increases in […]
Policy / Regulatory Changes · 67 signals · last 30 days -
Electronic Prior Authorization Arrives Jan. 1, 2027: What Hospitals Need to Know
As major provisions of the 2024 Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule take effect next year, hospitals and health systems should begin preparing for changes to prior authorization workflows, payer interactions and information exchange.On Jan. 1, 2027, many of the most significant provisions of the 2024 CMS Interoperability and Prior Authorization final rule will take effect for impacted Medicare Advantage organizations, Medicaid man...
Policy / Regulatory Changes · 67 signals · last 30 days -
Why CMS’ Medicare enrollment crackdown is alarming providers
The Centers for Medicare and Medicaid Services says limits on Medicare provider enrollment are needed to prevent fraud.
Policy / Regulatory Changes · 67 signals · last 30 days -
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-April Through June 2026
This quarterly notice lists Centers for Medicare & Medicaid Services (CMS) manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published in the 3-month period, relating to the Medicare and Medicaid programs and other programs administered by CMS.
Policy / Regulatory Changes · 67 signals · last 30 days -
HHS appeals decision vacating provisions of 2025 ACA marketplace rule
HHS and CMS appealed a Maryland federal court’s decision to vacate parts of CMS’ 2025 “Marketplace Integrity and Affordability Rule,” according to July court filings. In the Columbus I case — which has the city governments of Columbus (Ohio), Baltimore and Chicago, as well as other groups, as plaintiffs — the Maryland district court ruled on summary judgment in June […] The post HHS appeals decision vacating provisions of 2025 ACA marketplace rule appeared first on Becker's Payer Issues | Pay...
Policy / Regulatory Changes · 67 signals · last 30 days -
Indiana home-based Medicaid provider enrollment freeze on the horizon
Indiana Health Coverage Programs got CMS approval to progress with an enrollment and certification moratorium for some Medicaid providers beginning Aug. 1. According to a July 23 bulletin, the freeze will continue for six months. IHCP can extend the pause in six-month increments. The moratorium will target home- and community-based services 1915(c) waiver providers. Affected services include […] The post Indiana home-based Medicaid provider enrollment freeze on the horizon appeared first on B...
Policy / Regulatory Changes · 67 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 · 67 signals · last 30 days -
New CMS data spotlight continued rise in No Surprises Act disputes
The number of out-of-network billing disputes proceeding to arbitration continues to grow, much to the consternation of health plans.
Policy / Regulatory Changes · 67 signals · last 30 days -
Whistleblower alleges Cambia knowingly kept Medicare Advantage overpayments
A former employee of Cambia Health Solutions has accused the Portland, Ore.-based company of violating the False Claims Act by knowingly submitting inaccurate diagnosis data to CMS and failing to return Medicare Advantage overpayments. The whistleblower complaint, originally filed in 2020, was unsealed July 20 in a Washington state federal court. During that period, the […] The post Whistleblower alleges Cambia knowingly kept Medicare Advantage overpayments appeared first on Becker's Payer Is...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS issues implementation guidance following federal court injunction involving 2027 notice of benefit and payment parameters final rule
The Centers for Medicare & Medicaid Services July 22 released implementation guidance following a district court ruling July 16 that enjoined eight provisions from its 2027 notice of benefit and payment parameters final rule, which were set to become effective July 20. The rule issues standards for qualified health plans offered through the health insurance marketplaces. “Accordingly, for plan year 2026, Exchanges must immediately begin to update their systems to stop removing or denying adva...
Policy / Regulatory Changes · 67 signals · last 30 days -
No Surprises disputes continue to swell, CMS finds
Providers and payers initiated 16% more disputes in the second half of 2025 compared with the first half, according to new federal data. But arbiters are closing challenges more quickly and tackling a backlog of disputes.
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS stars redo lifts big Medicare Advantage insurers
UnitedHealthcare, Humana and Aetna are among the insurers that secured larger Medicare Advantage quality bonuses.
UnitedHealthcareHumanaUnitedHealthcare + Humana · 47 signals · last 30 days -
CMS appeals Clover MA stars lawsuit
Tuesday’s appeal is the latest development in Clover’s legal saga to get the CMS to recalculate its Medicare Advantage star ratings.
Policy / Regulatory Changes · 67 signals · last 30 days -
Va. hospitals predict $31B reduction in state’s Medicaid funding if proposed CMS rule passes
A proposed federal rule stemming from the reconciliation bill Congress passed last summer includes additional policy changes that would reduce Medicaid payments to healthcare facilities, a step hospital chains warn exceeds the provision Congress approved and President Donald Trump signed. Public comment closed this week on a rule proposed by the Centers for Medicare and […]
Policy / Regulatory Changes · 67 signals · last 30 days -
Notice of Public Data Asset Release Under the Open, Public, Electronic, and Necessary (OPEN) Government Data Act
In accordance with Title II of the Foundations for Evidence- Based Policymaking Act of 2018, known as the Open, Public, Electronic, and Necessary (OPEN) Government Data Act, CMS announces the forthcoming release of public data assets in open, machine-readable formats under an open license. These data are intended to support public engagement in identifying and preventing fraud, waste, and abuse, and to promote transparency and accountability. CMS has taken steps to ensure that the release of...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS appeals Clover’s Medicare Advantage star ratings win
CMS is appealing its court loss that led to boosts in Clover Health’s 2026 Medicare Advantage star ratings. The case will now move to the U.S. Court of Appeals for the Eleventh Circuit, according to a July 21 court filing. Clover sued CMS in November, opposing measures it said contributed to its largest MA contract’s […] The post CMS appeals Clover’s Medicare Advantage star ratings win appeared first on Becker's Payer Issues | Payer News .
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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 · 67 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 · 67 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.
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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 · 67 signals · last 30 days