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 CMS released 2026 Medicare Advantage star ratings showing mixed results for major insurers. Star ratings affect bonus payments and rebates, impacting insurer revenues and market strategy.
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 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.
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 enabling expanded coverage during COVID-19 expire in 2025. Providers must prepare for significant Medicare and regulatory changes affecting telehealth reimbursement and compliance.
