CMS Introduces ACO LEAD: Revolutionizing Medicare's Value-Based Care
Discover how CMS's ACO LEAD model enhances Medicare's value-based care, addressing provider participation challenges and improving care for high-need patients.
CMS Launches Pilot for Enhanced Medicare Advantage Authorization Processes
Discover how CMS's new pilot program will improve prior authorization in Medicare Advantage. Learn about data transparency and compliance implications for insurers.
GAO Report Reveals ACA Marketplace Vulnerabilities to Fraud
Discover vulnerabilities in the ACA marketplace as GAO reveals risks of fraudulent applications. Learn how to protect public funds—click for insights!
Senators Propose Legislation to Block AI Prior Authorization Pilot in Traditional Medicare
Senators introduce bill to stop AI-driven prior authorization pilot program in Traditional Medicare, citing risks to seniors' access to care and provider burden. Legislative effort targets CMS's WISeR model set for 2026 rollout.
2025 Year-End U.S. Healthcare and Insurance Regulatory Update
Key regulatory and legislative developments shaping U.S. healthcare and insurance in late 2025, including APTC expirations, CMS innovations, FDA initiatives, and congressional healthcare policy efforts.
CMS Payment Methodology Inflates Medicare Part B Costs for Stelara Biosimilars
CMS's current inclusion of noncovered self-administered drug prices in Medicare Part B payment calculations inflates costs for Stelara biosimilars. OIG recommends revising pricing methodology to achieve savings.
States Use Unused ACA Marketplace Premiums to Fund Abortion Services Amid CMS Guidance Debate
U.S. states leverage unused ACA Marketplace premiums to fund abortion services for low-income and uninsured populations, navigating legal frameworks under Section 1303 and CMS guidance challenges. Insight into regulatory compliance and health policy impacts.
2027 Medicare Advantage and Part D Proposed Rule: CMS Modernizes Quality Metrics and Risk Adjustment
CMS 2027 Proposed Rule aims to modernize Medicare Advantage and Part D programs with updates to quality metrics, risk adjustment models, and beneficiary protections. Key changes include Star Ratings revisions, incorporation of Inflation Reduction Act drug pricing provisions, and requests for stakeholder feedback on quality bonus payments and care coordination.
CMS Proposes 24 Quality Measures for Medicare Under Annual Review
CMS has published 24 quality and efficiency measures for Medicare programs, emphasizing digital data use and targeting chronic conditions and safety priorities. Public commentary is open through January 6.
CMS Examines Obamacare Subsidy Challenges; VA Announces Healthcare Workforce Cuts
CMS reviews Obamacare enhanced subsidy issues; VA plans healthcare workforce reductions; vaccine injury program advisory panel to meet post-Christmas.