Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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Amazon, Google among self-funded employers joining CMS' prior auth pledge
The Trump administration revealed Wednesday that five of the country's largest employers have signed on to expand electronic prior authorization in self-funded plans.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS News: Trump Administration Announces $32 Million to Recruit Rural Doctors, Train Healthcare Workers and Expand Emergency Mental Healthcare Across Mississippi
Trump Administration Announces $32 Million to Recruit Rural Doctors, Train Healthcare Workers and Expand Emergency Mental Healthcare Across Mississippi This federal investment will help rural communities recruit healthcare professionals and establish three psychiatric emergency units to connect patients with timely behavioral healthcare
Policy / Regulatory Changes · 140 signals · last 30 days -
‘The market is reaping the benefits’ of BCBS antitrust settlement, Elevance says
Newly enabled competition between Blue Cross Blue Shield plans is continuing to contribute to Elevance Health’s commercial insurance business, leadership said on the company’s quarterly earnings call Oct. 21. Dubbed the “second blue bid,” the provision stems from a $2.67 billion settlement that resolved class action allegations dating back to 2012 that BCBS plans conspired […] The post ‘The market is reaping the benefits’ of BCBS antitrust settlement, Elevance says appeared first on Becker's...
ElevanceBlue CrossElevance Health + Blue Cross Blue Shield plans · 48 signals · last 30 days -
STAT+: CMS extends fraud crackdown to New York’s adult day care program
CMS is cracking down on adult day cares in New York, part of a broader focus on alleged health care fraud.
Policy / Regulatory Changes · 140 signals · last 30 days -
Oracle, Amazon, Google among employers backing federal prior authorization reform push
Amazon, Axon, Google, Meta and Oracle are asking the insurers and third-party administrators that run their health plans to expand electronic prior authorization upgrades, first promised under a 2025 federal pledge, to the self-funded market. CMS and the Labor Department announced the employers’ statement of support Oct. 21. Self-funded employer plans aren’t subject to the […] The post Oracle, Amazon, Google among employers backing federal prior authorization reform push appeared first on Bec...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS defers $1.2B in Medicaid funds from California, puts New York on notice after raid
The Trump administration is withholding additional funds from California as part of its war with certain states over Medicaid fraud.
Policy / Regulatory Changes · 140 signals · last 30 days -
White House defers $1.2B more in California Medicaid payments
The White House is withholding another $1.2 billion in federal Medicaid payments to California, citing growth in the state’s personal care services spending. CMS Administrator Mehmet Oz, MD, made the announcement Oct. 20 in the Oval Office on behalf of HHS Secretary Robert F. Kennedy Jr. He pointed to concerns over California’s In-Home Supportive Services […] The post White House defers $1.2B more in California Medicaid payments appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
AHA comments to CMS on preliminary 2027 Medicare clinical laboratory fee schedule rates
The AHA submitted comments to the Centers for Medicare & Medicaid Services Oct. 21 on its preliminary calendar year 2027 Medicare clinical laboratory fee schedule rates. The AHA said the preliminary rates highlight the need for substantial reforms to CMS’ methodology, saying they are based on incomplete data. The AHA discussed the requirement under the Protecting Access to Medicare Act that called for hospital outreach laboratories and other clinical laboratories to report their private payer...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS announces five organizations sign prior authorization pledge
The Centers for Medicare & Medicaid Services Oct. 21 announced that Amazon, Axon Enterprise, Inc., Google, Meta and Oracle Corp. are in support of its prior authorization pledge announced last year. The pledge involves streamlining prior authorization processes and increasing transparency for patients and providers by 2027. The AHA recently launched a new website on prior authorization, containing prior authorization news and resources. The website will be updated with additional resources an...
Policy / Regulatory Changes · 140 signals · last 30 days -
New York payer says 2027 Medicare Advantage star rating will cost it $380M
Healthfirst is the latest insurer to sue the federal government in a bid to overturn its 2027 Medicare Advantage star rating it says will cost the plan more than $380 million. The New York City-based insurer, which has more than 300,000 MA enrollees, received a 3.5-star rating for 2027, down from 4.5 stars the prior […] The post New York payer says 2027 Medicare Advantage star rating will cost it $380M 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 Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), is providing notice of a computer matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA). The purpose of the matching program is to identify beneficiaries enrolled in both Medicare and VHA health care and to identify medical claims for which both agencies made pay...
Policy / Regulatory Changes · 140 signals · last 30 days -
3 most feasible Medicare Advantage reforms: Study
As Medicare Advantage faces concerns regarding plan oversight, possible overpayments and care access, RAND researchers assembled experts to unpack potential reforms. Published in Health Affairs Oct. 5, the study consisted of two rounds with nearly 40 panelists. They rated 15 policy reform ideas on a nine-point scale. These ideas had high-level framing and were drawn […] The post 3 most feasible Medicare Advantage reforms: Study appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
House bill targets Medicare Advantage star ratings methodology
A newly introduced House bill is targeting the methodology behind Medicare Advantage star ratings, adding more pressure to a program that has seen years of litigation from insurers. The Medicare Advantage Strengthening Transparency and Accountability in Rating Systems Act, or MA STARS Act, was introduced Sept. 21 by Rep. Mike Kelly, R-Pa., and would direct […] The post House bill targets Medicare Advantage star ratings methodology appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Healthfirst Health Plan Inc. v. Department of Health and Human Services et al.
Medicare Advantage Star Ratings litigation. The post Healthfirst Health Plan Inc. v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .
Policy / Regulatory Changes · 140 signals · last 30 days -
Judi Health launching employer Medicare Part D plan with a focus on transparency
Judi Health is launching a new Part D plan that aims to lean on its tech stack to drive transparency and outcomes.
Policy / Regulatory Changes · 140 signals · last 30 days -
Judi Health launches Medicare Part D plan for employer groups
Health technology and benefits administration platform Judi Health is launching a Medicare Part D plan called Judi Rx Retire, according to an Oct. 20 news release. The product is a CMS-contracted and -approved Employer Group Waiver Plan, meaning employers can offer this prescription drug coverage to their Medicare-eligible retirees. Judi Rx Retire includes pharmacy networks, […] The post Judi Health launches Medicare Part D plan for employer groups appeared first on Becker's Payer Issues | Pa...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS releases 2 qualifying payment amount audits
The Centers for Medicare & Medicaid Services Oct. 20 published two qualifying payment amount audits under the No Surprises Act. The audits were of CareSource in Indiana and the School Employees Retirement System in Ohio, with both required to complete corrective actions following the audits. The CareSource audit focused on almost 25,000 claims, primarily concerning emergency and non-emergency services, while the School Employees Retirement System audit focused on six air ambulance claims. Bot...
CareSource · 2 signals · last 30 days -
CMS urges marketplace insurers to have brokers record consumer calls
Leading up to marketplace open enrollment, CMS issued guidance to insurers Oct. 19, encouraging greater oversight of agents and brokers. The memo focuses on issuers using the federally facilitated exchange. CMS expects issuers to follow much of the guidance beginning Nov. 1, when the enrollment period kicks off. CMS recommended that issuers have their agents […] The post CMS urges marketplace insurers to have brokers record consumer calls appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026
This proposed rule would implement section 6219 (Adjustments to Medicare Part D Cost-Sharing Reductions for Low-Income Individuals), section 6220 (Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act), and section 6224 (Modernizing and Ensuring Pharmacy Benefit Manager Accountability) of the Consolidated Appropriations Act, 2026.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS lifts enrollment freeze on Massachusetts Medicare Advantage plans
CMS lifted an enrollment freeze for two contracts under eternalHealth, a Boston-based Medicare Advantage insurer, on Oct. 7. The agency imposed the freeze Aug. 27 after determining eternalHealth’s conduct “poses a serious threat to enrollee health and safety.” Earlier that month, the Massachusetts Division of Insurance placed eternalHealth under administrative supervision and required the insurer […] The post CMS lifts enrollment freeze on Massachusetts Medicare Advantage plans appeared first...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS issues proposals to improve MA plan provider directory accuracy, PBM transparency requirements and reduce drug costs
The Centers for Medicare & Medicaid Services released a proposed rule Oct. 16 seeking to codify regulations that will improve the accuracy of Medicare Advantage plan provider directories, establish transparency and compensation requirements for pharmacy benefit managers and their affiliates, and reduce copayments for generic drugs to $0 for low-income Medicare Part D beneficiaries. Among the proposed rule’s provisions, it would require MA plans to verify and update their provider directory in...
Policy / Regulatory Changes · 140 signals · last 30 days -
Maryland payer laying off 161 across 3 states
Provider Partners Health Plans is laying off 161 employees spanning three states, according to Oct. 7 Worker Adjustment and Retraining Notification, or WARN, notices. Provider Partners reported 79, 39 and 43 layoffs in Texas, Maryland and Illinois, respectively. The Texas and Maryland layoffs go into effect in early December. In late May, CMS said it […] The post Maryland payer laying off 161 across 3 states appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS proposes rule to clean up MA provider directories, shine light on PBMs
The proposed changes would implement key healthcare provisions in a government funding package from February. The brunt of the reforms would go into effect in 2028.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS proposes MA 'ghost network,' PBM transparency requirements
The administration took steps to codify statutory reforms focused on maintaining accurate Medicare Advantage provider directories and collecting more pricing information from pharmacy benefit managers.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS proposes public scores for Medicare Advantage provider directories, flat-fee limits for PBMs
CMS is pitching new guardrails for pharmacy benefit managers and Medicare Advantage plans under a proposed rule released Oct. 16. The proposed rule would implement sections of the Consolidated Appropriations Act of 2026. Comments are due Dec. 15. Here are eight things to know from the proposed rule: The post CMS proposes public scores for Medicare Advantage provider directories, flat-fee limits for PBMs appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days