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's 2025 payment updates introduce advanced primary care and behavioral health codes poised to reshape reimbursement landscapes, addressing primary care financial challenges and influencing specialist payment cuts.

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.

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

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

CMS invites states to apply for the $50B Rural Health Transformation program aimed at improving rural health outcomes, with a Nov. 5 deadline and specific funding rules.