Policy / Regulatory Changes
Signals classified into this topic vertical.
235 signals
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Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule (CMS-1848-P) — Medicare Shared Savings Program Proposals
Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule (CMS-1848-P) — Medicare Shared Savings Program Proposals
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement
CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS posts updated FAQ on PAMA clinical laboratory private payer data reporting
The Centers for Medicare & Medicaid Services has released an updated FAQ on Protecting Access to Medicare Act private payer data reporting. The deadline is July 31 for hospital outreach laboratories to report required private payer clinical diagnostic laboratory data to CMS for services furnished during the first six months of 2025. This includes Healthcare Common Procedure Coding System codes, associated private payer rates and volume data. A guide and other resources are also available from...
Policy / Regulatory Changes · 67 signals · last 30 days -
Draft guidance released for 2028 cycle of Medicare drug price negotiations
The Centers for Medicare & Medicaid Services July 16 released draft guidance for the 2028 cycle of negotiations under the Medicare Drug Price Negotiation program. Policies on incorporating drugs payable under Medicare Part B or covered under Part D are included in the guidance. It also describes procedures that may apply to drug manufacturers, Part D plan sponsors, Medicare Advantage organizations, pharmacies, mail order services and other Part D drug-dispensing entities, as well as hospitals...
Policy / Regulatory Changes · 67 signals · last 30 days -
Senate Republicans block effort to repeal Medicare AI prior authorization pilot
Senate Republicans have blocked an effort to advance a Democratic-led resolution to repeal CMS’ Wasteful and Inappropriate Service Reduction model, an AI-assisted prior authorization pilot within the traditional Medicare program. On July 16, senators voted 46-50 along party lines against a motion to move the measure forward. Oregon Sen. Ron Wyden, the ranking Democrat on […] The post Senate Republicans block effort to repeal Medicare AI prior authorization pilot appeared first on Becker's Pay...
Policy / Regulatory Changes · 67 signals · last 30 days -
Judge stays Trump administration policies set to shrink ACA marketplaces
On Thursday, a federal judge pressed pause on the CMS’ expansion of bare-bones catastrophic plans and other changes finalized in a rule this spring, saying they were likely to raise costs and hurt access.
Policy / Regulatory Changes · 67 signals · last 30 days -
Agency Information Collection Activities: Submission for OMB Review; 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 a second opportunity for public comment on the notice....
Policy / Regulatory Changes · 67 signals · last 30 days -
New Federal Medicaid Work Reporting Requirements Rule Threatens Coverage for Vulnerable Americans: An Explainer of the Interim Final Rule
On June 1, 2026, the Centers for Medicare & Medicaid Services (CMS), published the Interim Final Rule with Comment (CMS-2454-IFC, hereafter referred to as the IFR) “Medicaid Program; Community Engagement Requirement for Certain Individuals” as required by the 2025 Budget Reconciliation Law (hereafter referred to as H.R. 1). States that have expanded Medicaid to adults […]
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS announces national implementation of risk-based survey process for high-performing nursing homes
The Centers for Medicare & Medicaid Services July 16 announced nationwide implementation of a new risk-based survey review process for high-performing nursing homes. CMS pilot tested the RBS process in more than 100 facilities in 22 states beginning in 2023. The initiative includes the addition of an icon on higher performing facilities in CMS’ Care Compare tool. CMS said the approach would reduce time required and staff members needed to conduct standard recertification surveys at higher per...
Policy / Regulatory Changes · 67 signals · last 30 days -
Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
This proposed rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; codification of establishment of new policies for: the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; the Ambulatory Specialty Model; updates to drugs and biological products paid under...
Policy / Regulatory Changes · 67 signals · last 30 days -
AHA responds to CMS on potential modifications to ACA’s Essential Health Benefits
The AHA July 15 responded to a request for information from the Centers for Medicare & Medicaid Services on the Affordable Care Act’s Essential Health Benefits framework, which creates the guardrails for defining comprehensive insurance coverage. The AHA supported updating the EHBs to reflect a changing healthcare landscape but cautioned CMS against changes to the EHBs that would dilute coverage, noting that affordability cannot be measured by premiums alone and that adequate coverage is esse...
Policy / Regulatory Changes · 67 signals · last 30 days -
Medicare doctor pay would dip slightly under proposed rule for 2027
Medicare pay cuts may return in 2027 after Congress gave physicians a one-year reprieve for this year.
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS’s 2027 OPPS Proposed Rule Advances 340B Payment Reform, Site Neutrality, and Program Integrity
The post CMS’s 2027 OPPS Proposed Rule Advances 340B Payment Reform, Site Neutrality, and Program Integrity appeared first on Paragon Health Institute .
Policy / Regulatory Changes · 67 signals · last 30 days -
Efforts to reform federal drug pricing program 340B continue with new report, proposed CMS rule
The federal drug pricing program 340B helps hospitals and clinics in Virginia and across the nation care for underserved patients by requiring pharmaceutical companies to offer prescription discounts to qualifying providers. But after some providers were caught taking advantage of the program and shortchanging patients, state and federal lawmakers have spent years deliberating potential reforms. […]
Policy / Regulatory Changes · 67 signals · last 30 days -
Health Insurance Marketplaces: CMS Needs Stronger Controls to Prevent Unauthorized Actions by Agents and Brokers
What GAO Found Millions of consumers rely on the assistance of health insurance agents and brokers to purchase health insurance plans through federal and state Marketplaces established by the Patient Protection and Affordable Care Act. The federal Marketplace is maintained by the Centers for Medicare & Medicaid Services (CMS). To assist consumers in the federal Marketplace, agents and brokers must be licensed to sell health plans and be registered with the Marketplace, among other things. CMS...
Policy / Regulatory Changes · 67 signals · last 30 days -
Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al.
Medicare Advantage Star Ratings litigation. The post Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .
Alignment HealthcareAlignment Healthcare · 2 signals · last 30 days -
CMS reports strong ACO REACH savings before model sunsets
Results published this week from the Centers for Medicare and Medicaid Services show ACO REACH closed out 2024 with strong savings and quality performance.
Policy / Regulatory Changes · 67 signals · last 30 days -
Medicare and Medicaid Programs; Application From The Joint Commission for Continued CMS Approval of Its Home Health Agency (HHA) Accreditation Program
This notice announces our decision to approve The Joint Commission for continued CMS recognition as a national accrediting organization for home health agencies that wish to participate in the Medicare or Medicaid programs.
Policy / Regulatory Changes · 67 signals · last 30 days -
CVS, Omnicare reach $440M settlement with Justice Department
CVS Health plans to sell its Omnicare pharmacy services subsidiary to GenieRx Holdings.
CVS HealthCVS Health / Aetna · 10 signals · last 30 days -
CMS Approach to Work Reporting Requirement Won’t Work for People with Substance Use Disorders or Mental Health Conditions
By Deborah Steinberg, Senior Health Policy Attorney, Legal Action Center A few weeks ago, CCF explained how the Centers for Medicare & Medicaid Services (CMS) issued a new interim final rule with comment period (IFR) that went far beyond its authority to implement the new work reporting requirements. H.R. 1 – the budget reconciliation law […]
Policy / Regulatory Changes · 67 signals · last 30 days -
SCAN Health Plan v. Department of Health and Human Services et al.
Medicare Advantage Star Ratings litigation. The post SCAN Health Plan v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .
SCANSCAN Health Plan · 11 signals · last 30 days -
Revalidation of ‘High-Risk’ Medicaid Providers: Early Lessons from Minnesota
On April 23, the CMS Administrator, Dr. Mehmet Oz, issued a letter to State Medicaid Directors “formally asking that your state develop and submit a comprehensive two-year provider revalidation (PR) strategy….” This SMD is not posted on Medicaid.gov with all the other SMDs, but you can view it on the Fox News website. The state […]
Policy / Regulatory Changes · 67 signals · last 30 days -
Digital Health Tools and Technologies: An Overview of CMS’ Recent Efforts to Expand Their Use in Medicare
As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. This brief summarizes these initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to highlight facts...
Policy / Regulatory Changes · 67 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 Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of a re-established matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), titled, "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act". Under this Matching Program, CMS will share da...
Policy / Regulatory Changes · 67 signals · last 30 days -
Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies
This proposed rule would set forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this proposed rule discusses the behavior adjustment and proposes a temporary behavior adjustment and proposes to recalibrate the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low- utilization payment adjustment (LUPA) thresholds for CY 2027. Additionally, this proposed rule discu...
Policy / Regulatory Changes · 67 signals · last 30 days