This week The Centers for Medicare & Medicaid Services announced that it is lifting a suspension on hospital survey activities that was implemented during this winter's surge in COVID-19 cases and hospitalizations. An immediate resumption of...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) targets new oversight of Medicaid demonstration project spending authorization through Section 1115 waivers. Nearly all states use demonstration waivers, including Arizona.
Late last week, CMS issued the new guidance for upcoming demonstrations beginning January 1, 2027. From that...CMS Rules
A federal judge has vacated most of the provisions in a Centers for Medicare and Medicaid Services (CMS) rule that intended to significantly alter eligibility and enrollment requirements for the Affordable Care Act (ACA) health insurance exchange. Elsewhere, the agency is requesting feedback for the ACA's essential health benefits...CMS Rules
As details come into focus of the federal work requirements that will be imposed on state Medicaid programs next year, health systems are preparing for how the cuts will undermine their bottom line.
The new rules, released earlier this month, detail a much stricter work requirement program than initially predicted, and many recipients...CMS Rules
Criticism continues to mount against the Trump administration's plan to use AI-based prior authorization for Medicare claims. The Wasteful and Inappropriate Service Reduction (WISeR) model, now active in Arizona and five other states, has already generated reports of delayed care for seniors since its January launch. On Tuesday, a House...CMS Rules
The provision getting the most attention in the interim final rule is that HHS declined to give states flexibility to create additional categories of "medically frail" Medicaid beneficiaries exempt from the new work requirements. The agency said the five exemption categories established in federal law are broad enough to cover...CMS Rules
Last week, the Departments of Health and Human Services (HHS), Treasury and Labor in partnership with the White House Office of Personnel Management (OPM) finalized a rule that would overhaul the dispute resolution framework for the No Surprises Act.
The rule will reduce administrative fees for disputes from $115 to $15 per dispute,...CMS Rules
Last summer, Congressional Republicans rallied to pass the One Big Beautiful Bill Act (OBBBA), which funded the Trump administration's agenda largely through cuts and alterations to the Medicaid program. Now, the administration is crafting rules to follow through on the directives in the bill, and is met with protest from provider groups...CMS Rules
Almost one year ago, 50 major health insurers met with U.S. health department leadership and pledged to rein in their use of prior authorization, which patients and providers complain severely disrupts the continuity of care. Now, despite industry studies demonstrating that the practice has been curbed by a little over 10%, the practice...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will implement new policies next year including eligibility restrictions and expanded access to non-traditional health plans.
The rules will allow plans that otherwise would not qualify for the Affordable Care Act's (ACA) insurance exchange,...
The Centers for Medicare & Medicaid Services is temporarily halting approvals of new hospice and home health agencies nationwide for six months, an unusually aggressive anti-fraud action that carries particular relevance in Arizona, one of the nation’s fastest-growing hospice markets in recent years.The six-month moratorium marks...CMS Rules
The Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway is designed to streamline communication from the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to manufacturers in the early stages of product development, allowing Medicare beneficiaries to participate in...CMS Rules
As insurance companies raise flags about the cost of GLP-1 weight loss drugs in coordination with government payer programs, the Trump administration has rescinded its plan to have insurance companies fund coverage of the obesity drugs and will have Medicare pay the cost instead.
Last year, the White House announced a landmark deal...
Last Thursday, the Centers for Medicare and Medicaid Services finalized a rule that overhauls the Star quality rating system for Medicare Advantage programs, cutting several measures, including the health equity index. The changes are anticipated to net insurers $18.6 billion over the next ten years.
In lieu of the health equity...
On April 2, the Centers for Medicare and Medicaid Services (CMS) proposed three of the four provider types, SNFs, hospices, and inpatient rehabs, are slated to receive a 2.4% pay increase, and inpatient psychiatric facilities are up for 2.3% in 2027. In the SNF proposed rule, CMS requested information for potential updates to the Patient...
The Centers for Medicare & Medicaid Services (CMS) on Monday finalized a stronger-than-expected payment update for Medicare Advantage (MA) plans in 2027, backing off from an earlier proposal from the agency that signaled flat funding, which triggered industry concern over benefit cuts and market exits.
CMS said the final rate...
Prior authorization, or the insurance practice of requiring authorization prior to the delivery of care or dispensation of drugs, has been under fire for the consequences of restricting timely access to care. Now, payers will be required to post data on how often they deny requests, how quickly they process them and how often denials are...CMS Rules
This week, the Centers for Medicare and Medicaid Services (CMS) announced a new payment model that aims to bolster comprehensive health coverage for children with complex medical and behavioral health needs. The Accelerating State Pediatric Innovation Readiness and Effectiveness (ASPIRE) Model is a state-based model that will serve...
Last Thursday, the Medicare Payment Advisory Commission (MedPAC) submitted its annual March Report to Congress. The Congressional advisory panel has long been critical of the Medicare Advantage (MA) program, but in this report it finds that the federal government will pay 14% more than if the 35 million beneficiaries enrolled in the...
New policies from the Centers for Medicare and Medicaid Services are disrupting rural health clinics' participation in value-based payment models. But a new study shows that while federal programs have increased patient access and quality of care, they have thus far failed to curb rising costs.
When the Trump administration entered...
Early this week, the Centers for Medicare and Medicaid Services (CMS) posted a proposed rule that would overhaul Affordable Care Act (ACA) exchange plan regulations, including ending standardized coverage and broadening access to catastrophic plans.
The rule would repeal a 2023 requirement that federal exchanges and state-based...
