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.

The U.S. government passed H.R. 5371, ending the shutdown and extending Medicare telehealth flexibilities through January 2026, ensuring continued coverage and retroactive payments for telehealth claims.

CMS introduces the Ambulatory Specialty Model, a new mandatory payment model for specialists treating low back pain and heart failure, effective from 2027 to improve care quality and reduce costs.

CMS issues National Coverage Determination for FDA-approved renal denervation treatment under Coverage with Evidence Development for uncontrolled hypertension in Medicare patients.

Federal court upholds CMS's star rating methods after Humana challenges foreign language interpreter test policy, impacting Medicare Advantage market competition and insurer revenues.

CDPHP earns top NCQA and CMS 4.5-star ratings in 2025 for commercial and Medicare health plans, highlighting strong quality and member care in New York's insurance market.

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.

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 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.

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.