INSURASALES

Tag: CMS

Medicare Telehealth Waivers Expire, Impacting Access and Hospital-at-Home Programs

Medicare telehealth waivers and hospital-at-home programs expired on Sept. 30, risking reduced access to telehealth services for Medicare patients and operational pauses in hospital-at-home programs. Stakeholders call for permanent regulatory solutions.

AHA Urges HHS and CMS to Enforce Prior Authorization Reforms

The American Hospital Association urges CMS and HHS to enforce prior authorization reforms to reduce hospital staff workload and patient delays, emphasizing implementation of electronic standards and monitoring compliance.

Trump Administration Launches AI-Driven Prior Authorization Pilot in Medicare

The Trump administration introduces WISeR, an AI-driven pilot program expanding prior authorization in Medicare to reduce wasteful services, raising industry and regulatory debates on care delays and oversight.

Georgia Secures Federal Extension for Medicaid Work Requirement Program

Georgia obtains a one-year federal extension for its Medicaid Pathways to Coverage work requirement program, with eased reporting rules and expanded eligibility, amid administrative cost scrutiny.

AI-Assisted Prior Authorization Pilot Launches in Washington Medicare

The federal government starts a 6-year AI-assisted prior authorization pilot in Washington and five other states to improve Medicare coverage decisions for costly procedures.

FDA Approves Leucovorin for Autism Amid Investment and Regulatory Clarifications

FDA approves prescription leucovorin for autism treatment; HHS addresses investment and regulatory concerns involving CMS administrator Dr. Mehmet Oz amid public discourse.

Medicare Telehealth Waivers Expire in 2025: Providers Must Prepare Now

Medicare telehealth waivers enabling expanded coverage during COVID-19 expire in 2025. Providers must prepare for significant Medicare and regulatory changes affecting telehealth reimbursement and compliance.

Medicare Advantage Faces $5.7 Billion Underwriting Loss Amid Rising Costs in 2024

Medicare Advantage incurs a $5.7 billion underwriting loss in 2024 due to increased utilization, medical inflation, and regulatory changes, impacting insurer profitability and market dynamics.

Medicare Faces AI-Driven Prior Authorization Pilot Amid Budget Cuts

Medicare to pilot AI-driven preauthorization program in six states as federal budget cuts threaten program funding and patient access.

OIG Report Reveals Underreporting of Major Injury Falls in Medicare Nursing Homes

OIG finds nursing homes underreporting major injury falls affecting accuracy of CMS Care Compare data; CMS to enhance compliance and reporting measures.