This week, the Trump administration announced new guidelines for Medicaid's oversight of autism therapy, a rapidly growing medical business that has been criticized for a lack of standards and oversight. The recommendations focus primarily on applied behavior analysis (ABA),
Earlier this year, the Office of Inspector General (OIG) at...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) continues its efforts to curb the use of provider taxes as directed by the One Big Beautiful Bill Act of 2025 (OBBBA, H.R. 1). In a proposed rule issued last week, CMS announced it would go beyond what the law requires to further restrict the financing mechanism states use to increase...White Papers, E books, Reports and more
National health spending is accelerating according to a new report from the Centers for Medicare and Medicaid Services' (CMS) Office of the Actuary. The rate of growth is expected to propel total spending to $9 trillion and 20.6% of gross domestic product by 2034.
Health spending is estimated to have increased 7.3% to 5.7 trillion in...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...White Papers, E books, Reports and more
Last week, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released a white paper on its recommendations for value-based care model alignment policies for nursing facilities and assisted living communities.
AHCA argues in the paper, titled "Advancing Accountable Care for Long Term Care...CMS Rules
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...
The notion that a Republican administration would be inherently favorable to Medicare Advantage (MA) is being tested. From CMS’ decision to hold MA rates flat for next year, to the DOJ's continued enforcement actions related to MA billing and the OIG's heightened scrutiny of upcoding practices, MA stakeholders are preparing for a bumpy...
The Rural Health Transformation Program (RHTP), which was initially proposed to offset rural health system losses due to Medicaid cuts, has become the centerpiece of the Trump administration's approach to innovating healthcare solutions on a geographic basis. A new report from Georgetown's Center on Health Insurance Reforms (CHIR) shows...
The agency estimates that there were $28.83 billion in improper payments to traditional Medicare, which it estimates are down from $31.7 billion in 2024. The Center for Medicaid & Medicare Services acknowledges improper payments are not indicative of fraud or abuse but are typically the result of clerical error.
The agency looked...National News
The new platform, called ClaimsCore, is intended to unify the Multi-Carrier System, the Fiscal Intermediary Shared System, ViPS Medicare System and the Common Working File.
ClaimsCore is designed by the feds to deliver immediate improvements to the Medicare experience while enabling deeper, future transformation fit for today's...CMS Rules
Last week, the Centers for Medicare and Medicaid Services made hospitals very unhappy with the 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS) final rule, which includes major plans for site-neutral payments and price transparency policies.
The rule gives both outpatient departments and...National News
The Medicare Advantage field is changing as costs of care challenge payor and provider participation, and as provider directories on Medicare Plan Finder prove problematic.
Wall Street is reportedly disillusioned with the prospect of market growth since the MA industry eclipsed 50% of the Medicare market share. According to Modern...
As the government shutdown drags on, President Donald Trump has ordered firings of thousands of furloughed federal employees and threatened to further cut "Democrat programs." Additionally, the Centers for Medicare and Medicaid Services (CMS) announced that it will pause Medicare payments to doctors.
Late Wednesday, STAT News reported...
The federal government has shut down as the Congressional Republicans and Democrats battle over continuation of the ACA enhanced tax credit subsidies for citizens buying health insurance.
Republicans initially put forward a "clean" continuing resolution (CR) that would have kept the government open through the month of October, but...Arizona News
On Sept. 18, 2025, a coalition of Democratic congresspeople introduced the Patients Over Profits Act, which would bar insurers and their subsidiaries from owning Medicare Part C or D providers, require divestitures of existing holdings, and prevent the Centers for Medicare and Medicaid Services (CMS) from contracting with Medicare...CMS Rules
In lieu of extending the Affordable Care Act (ACA) enhanced premium tax credits, the Trump administration is boosting access to catastrophic plans.
Catastrophic plans cover preventative care but carry very high deductibles. Historically, they've only been available for people under 30 who don't otherwise qualify for subsidies, but the...National News
Congressional Republicans and the Trump administration expected to curb the impact of Medicaid cuts on rural hospitals by introducing a $50 billion rural health fund for a “rural health transformation program.”
The fund will only cover around one-third of the estimated loss of federal Medicaid funding in rural areas, and is only...CMS Rules
Last week, a coalition of Democratic-led states filed suit against the Trump administration's Centers for Medicare and Medicaid Services (CMS), in response to a final rule issued by the agency. The rule adds acute regulations to the Affordable Care Act (ACA) marketplace, which the plaintiffs allege will cause the number of uninsured...National News
Medicare Advantage insurers are having a tough time. Humana was forced to refile its lawsuit against the Centers for Medicare and Medicaid Services (CMS) over inappropriate star ratings awards as it scales back its use of prior authorizations. Meanwhile, the American Hospital Association (AHA) testified in Congress about the problems...National News
This week, the Centers for Medicare and Medicaid Services (CMS) announced plans to crack down on double-enrollment in Medicaid and end demonstration waivers for continuous enrollment in Medicaid.
CMS sent letters to states notifying them that it will end 1115 demonstration waivers that allow people to continuously enroll in Medicaid...
