Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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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 -
Preliminary Calendar Year (CY) 2027 Medicare Clinical Laboratory Fee Schedule Payment Rates
Preliminary Calendar Year (CY) 2027 Medicare Clinical Laboratory Fee Schedule Payment Rates The Centers for Medicare & Medicaid Services (CMS) posted preliminary weighted median private payor rates for certain clinical diagnostic laboratory test codes, marking a key step toward setting Medicare's calendar year (CY) 2027 payment rates under the Clinical Laboratory Fee Schedule (CLFS). This preliminary data reflects the second full data collection and reporting cycle for most tests required und...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Announces New Preliminary Medicare Payment Rates for Laboratory Services, Saving Taxpayers an Estimated $1 Billion Annually
CMS Announces New Preliminary Medicare Payment Rates for Laboratory Services, Saving Taxpayers an Estimated $1 Billion Annually
Policy / Regulatory Changes · 140 signals · last 30 days -
Court greenlights Chapter 11 plan for CVS’ Omnicare
A federal judge in Texas signed off on the Chapter 11 bankruptcy plan for Omnicare, CVS Health’s long-term care pharmacy, Sept. 17. Omnicare filed for Chapter 11 protection in 2025 in the wake of a false claims case that neared a $950 million judgment. Under the plan, the settlement between CVS and the Justice Department […] The post Court greenlights Chapter 11 plan for CVS’ Omnicare appeared first on Becker's Payer Issues | Payer News .
CVS Health TexasCVS Health / Aetna · 12 signals · last 30 days -
The lowest-rated health plans of 2026: NCQA
Of the 956 health plans rated by the NCQA in 2026, 15 received a rating of 2 stars or lower. The ratings, published Sept. 15, evaluate plans on clinical quality, patient experience and health plan accreditation status. A total of 18 plans received a 5-star rating. See the list of the best-rated plans here. Lowest-rated […] The post The lowest-rated health plans of 2026: NCQA appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
ACHP Urges CMS to Protect Medicaid Provider Tax Flexibility
ACHP asks CMS to implement OBBBA without added limits on provider taxes — preserving prospective compliance, the 75/75 test and state Medicaid financing. Source
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS says all states have applied for GENEROUS Model to provide most-favored-nation drug pricing
The Centers for Medicare & Medicaid Services announced Sept. 18 that all 50 states, Washington, D.C., and Puerto Rico have applied to participate in its initiative to make certain prescription drugs available to people with Medicaid at prices aligned with those paid in other countries, known as most-favored-nation pricing. The initiative, called the GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model, is being implemented by the CMS Innovation Center. CMS said that 40 states and Pue...
Policy / Regulatory Changes · 140 signals · last 30 days -
AHA recommends changes to CMS’ Medicaid provider tax proposed rule
The AHA commented Sept. 21 on the Centers for Medicare & Medicaid Services’ proposed rule to implement the changes to Medicaid provider tax policies that were included in the July 2025 reconciliation law. Beginning in fiscal year 2027, all states are prohibited from increasing the provider tax indirect hold harmless threshold above the rate that was in place on the date of enactment. The indirect hold harmless threshold is the maximum percentage of net patient revenue that states can gather f...
Policy / Regulatory Changes · 140 signals · last 30 days -
Every state to join CMS Medicaid drug pricing model: 4 notes
Forty states and Puerto Rico have signed agreements to join the Generous Model, a Medicaid drug payment initiative that ties prices for certain prescription drugs to what other developed nations pay, CMS announced Sept. 18. Four things to know: 1. All 50 states, the District of Columbia and Puerto Rico applied to participate. The remaining […] The post Every state to join CMS Medicaid drug pricing model: 4 notes appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS restores $12B in frozen supplemental Medicaid funds
The pause that began Sept. 1 had triggered alarm bells from provider groups and prompted an appeal from Texas Governor Greg Abbott.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Announces Participants in Landmark Medicaid Drug Payment Model to Bring Down Drug Costs for Most Vulnerable Americans
CMS Announces Participants in Landmark Medicaid Drug Payment Model to Bring Down Drug Costs for Most Vulnerable Americans
Policy / Regulatory Changes · 140 signals · last 30 days -
20+ states sue CMS over rule cutting Medicaid funds for youth gender-affirming care
Twenty-one states, plus the District of Columbia, filed a lawsuit Sept. 2 against HHS and CMS, challenging a rule that will cut off Medicaid and CHIP federal funds for youth gender-affirming care. The rule, released in August and set to take effect Oct. 13, restricts states from using Medicaid federal matching funds for puberty blockers, […] The post 20+ states sue CMS over rule cutting Medicaid funds for youth gender-affirming care appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
The best-rated Medicare Advantage plans in 2026: NCQA
Five Medicare Advantage plans scored a full five stars in this year’s health plan rankings from the National Committee for Quality Assurance, up from three in 2025. An additional 15 plans, including five more Kaiser health plans from around the country, scored 4.5 stars in 2026. The ratings were released Sept. 15 and are based […] The post The best-rated Medicare Advantage plans in 2026: NCQA appeared first on Becker's Payer Issues | Payer News .
KaiserKaiser Permanente · 4 signals · last 30 days -
Immediate jeopardy lifted at Ascension St. Thomas Hospital, but Medicare termination threat remains
Immediate jeopardy has been fully removed at Ascension St. Thomas Hospital in Nashville, Tenn., following a Sept. 4 revisit survey, according to a Sept. 16 letter obtained by Becker’s. But a 99-page Statement of Deficiencies shows the hospital remains out of compliance on several fronts, and a possible Medicare termination looms ahead. CMS had originally […] The post Immediate jeopardy lifted at Ascension St. Thomas Hospital, but Medicare termination threat remains appeared first on Becker's...
Policy / Regulatory Changes · 140 signals · last 30 days -
Oura, Counsel Health join CMS ACCESS model to test whether wearables and AI can improve chronic care at scale
Counsel Health, an AI-native primary care company, plans to participate in CMS' ACCESS Model under the early cardio-kidney-metabolic track, with smart ring maker Oura serving as the preferred wearable partner.
Policy / Regulatory Changes · 140 signals · last 30 days -
Federal watchdog accuses Humana, UnitedHealthcare Medicare Advantage plans of upcoding
Newly released HHS OIG audits of HumanaChoice and UnitedHealthcare of Wisconsin found both plans frequently exaggerated the health needs of their members, generating almost $180 million in overpayments over two years.
UnitedHealthcare + Humana · 59 signals · last 30 days -
Ohio report cards show 38 school districts need help to meet state standards
About 6% of Ohio school districts need support to meet state standards, according to the new state report cards the Ohio Department of Education and Workforce released Tuesday. The department uses 1 to 5 star ratings in half increments based on six categories: achievement (25% weight toward overall rating), progress (25%), early literacy (12.5%), gap […]
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicaid: Improved Oversight Needed of State Eligibility Error Corrective Action Plans
What GAO Found The Centers for Medicare & Medicaid Services (CMS) oversees the accuracy of Medicaid eligibility determinations through the Payment Error Rate Measurement (PERM) and the Medicaid Eligibility Quality Control (MEQC) programs. CMS estimates improper payments due to eligibility errors through its PERM program, and both the PERM and MEQC programs identify the root and specific causes of Medicaid eligibility errors and require states to develop corrective action plans (CAP) to addres...
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare and Medicaid Programs; Application From DNV Healthcare USA Inc. (DNV) for Continued CMS-Approval of its Hospital Accreditation Program
This notice acknowledges the approval of an application from DNV Healthcare USA Inc. (DNV) for continued CMS recognition as a national accrediting organization for hospitals that wish to participate in the Medicare or Medicaid programs.
Policy / Regulatory Changes · 140 signals · last 30 days -
STAT+: GOP aims to change Medicare adviser’s math so it’s more favorable to health insurers
The GOP bill directs MedPAC to study the topic of overpayments to Medicare Advantage plans in a manner that’s more favorable to insurers.
Policy / Regulatory Changes · 140 signals · last 30 days -
Survey to assess readiness for electronic prior authorization standards open until Oct. 9
The Workgroup for Electronic Data Interchange has launched its fall 2026 survey to assess industry readiness for the Centers for Medicare & Medicaid Services’ interoperability and prior authorization final rule. Survey responses are anonymous, and all results are aggregated. The survey will close on Oct. 9. WEDI plans to use the results to make recommendations to CMS, inform stakeholders and assist WEDI in its development of industry guidance and education.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS announces expansion of ACCESS Model
The Centers for Medicare & Medicaid Services Sept. 15 announced an expansion of its outcome-aligned payment model offering technology-supported care to individuals with Original Medicare. The Advancing Chronic Care with Effective Scalable Solutions Model, or ACCESS, will now offer care options to beneficiaries with heart failure, chronic obstructive pulmonary disease, substance use disorders and nicotine dependence. CMS said the new condition tracks will begin in spring 2027. The voluntary mo...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS extends ACCESS model to more chronic conditions as agency officials eye cross-payer alignment
The Trump administration is rapidly expanding its 10-year ACCESS Model, a value-based payment program that reimburses digital health companies based on patient outcomes rather than services delivered.
Policy / Regulatory Changes · 140 signals · last 30 days -
Why Network Health went live early with Epic’s prior auth interface
CMS’ interoperability rule will require many insurers to have application programming interface capabilities by Jan. 1, 2027. The clock is ticking, but some health plans are ahead of the curve. CMS is seeking patient access, provider access, provider directory, payer-to-payer and prior authorization APIs. Epic has been working with many payers toward the prior authorization […] The post Why Network Health went live early with Epic’s prior auth interface appeared first on Becker's Payer Issues...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS to add more chronic conditions to ACCESS model in 2027
The Trump administration is expanding Medicare’s new technology-based payment experiment to cover more chronic conditions, including COPD, substance use disorder and tobacco cessation.
Policy / Regulatory Changes · 140 signals · last 30 days