Medicare initiates an AI-based pilot program to aid in approving or denying certain medical procedures, raising considerations about healthcare administrative processes and payer-provider dynamics.
CMS initiates a six-state pilot requiring prior authorization in traditional Medicare to target overuse and cut costs, testing expanded regulatory controls familiar in Medicare Advantage.
The Medicare program will start an AI-driven prior authorization pilot for certain procedures in traditional Medicare, aiming to improve cost efficiency and coverage decisions. This initiative launches in six states with plans for potential expansion.
Overview of the 2025 federal healthcare regulatory agenda under the Trump administration, including Medicare rules, ACA integrity measures, and ongoing regulatory reviews impacting healthcare compliance and payer/provider operations.
Explore essential Medicare enrollment strategies and supplemental coverage options to control rising healthcare costs for retirees. Learn about enrollment periods, penalties, and annual plan reviews for better retirement healthcare planning.
The DOJ is broadening its investigation of UnitedHealth Group, examining prescription management practices at Optum Rx and physician reimbursement methods amid concerns beyond Medicare fraud.
A federal judge blocks major provisions of CMS's new ACA Marketplace rule, pausing stricter eligibility checks and subsidy limits that affect coverage for 1.8 million people.
AM Best revises US health insurance outlook to negative due to rising medical utilization, increased specialty drug use, and regulatory challenges impacting Medicare Advantage and Medicaid programs. Premiums projected to rise up to 60% by 2025.
House Resolution 1 enacts major Medicare and Medicaid reforms, affecting millions of Americans including immigrants and low-income families, with implications for insurance markets and healthcare providers.
CMS will not approve new Medicaid 1115 waivers for workforce initiatives, shifting federal support away from addressing provider shortages via these programs. This change affects state capacity to invest in Medicaid workforce development.
