CMS’s 2026 OPPS final rule updates outpatient payment policies, adjusts 340B drug recoupment, extends site-neutral payment models, expands ASC services, and enhances hospital price transparency requirements effective January 2026.
CMS proposes extensive 2027 changes to Medicare Advantage and Part D, including Star Ratings overhaul and $14B spending increase. Insurers should assess impacts on quality bonuses and compliance.
GAO report reveals systemic fraud in ACA marketplace subsidies, causing billions in improper payments and driving up healthcare costs. Policy reforms seek to improve program integrity and reduce premiums.
CMS announces increases in Medicare Parts A and B premiums and deductibles for 2026, reflecting rising medical costs and usage. Explore implications for senior care, Medicaid, and insurance professionals.
CMS extends its Medicare Inpatient Rehabilitation Facility Review Choice Demonstration to include Texas and California IRFs, increasing claims oversight and regulatory compliance requirements.
The CMS ACCESS Model launches in 2026 to pilot outcome-focused payments in Original Medicare, expanding technology-supported chronic care and integrating with primary providers for improved patient outcomes.
Explore Medicaid intergovernmental transfers (IGTs) abuse, federal oversight challenges, and policy reform opportunities to restore Medicaid fiscal integrity and ensure equitable provider payments.
The Medicare Diabetes Prevention Program has enrolled less than 1% of eligible beneficiaries since 2018 due to administrative, referral, and awareness challenges despite proven effectiveness. CMS changes aim to improve access and provider reimbursement.
CMS introduces the ACCESS Model to enhance chronic care for Medicare beneficiaries using digital health tools and outcome-based payment models starting in 2026.
CMS introduces ACCESS model to enhance technology-supported care and outcome-based payments for Medicare patients with chronic conditions starting in 2026.
