Tag: CMS

CMS Launches Health Data Sharing Initiative With Major Tech Firms

CMS Launches Health Data Sharing Initiative With Major Tech Firms

Trump administration's new health data sharing initiative involves major tech companies to improve patient access to health records, focusing on interoperability, AI-driven tools, and data privacy concerns.

2026 Medicare Part D Updates: Premium Increases, Penalties, and Cost Caps

Explore the 2026 Medicare Part D updates including premium increases, delayed enrollment penalties, and maximum out-of-pocket caps for prescription drugs, with insights into Medicare Advantage plan impacts.

CMS Proposes Voluntary Medicaid and Medicare GLP-1 Coverage Trial

CMS plans a voluntary five-year trial allowing state Medicaid and Medicare Part D plans to cover GLP-1 weight management drugs, including Ozempic and Wegovy, starting in 2026-27 amid pricing and coverage challenges.

Senators Propose Bill to Tighten Medicare Advantage Risk Adjustment, Curb Overpayments

Senators introduce bipartisan bill targeting Medicare Advantage overpayments by refining risk adjustment and supporting CMS audits to enhance program integrity and save Medicare billions.

CMS Price-Substitution Policy Saves $76M on Medicare Drugs Since 2013

CMS's price-substitution policy has saved $76 million for Medicare by correcting drug pricing identified by the Office of Inspector General, improving cost efficiency while maintaining access.

ACA Marketplaces Face Enrollment and Cost Challenges From New Federal Policies

New federal rules and tax law changes reduce subsidies and tighten enrollment in ACA marketplaces, risking higher premiums and lower enrollment, especially among lawfully present immigrants. States challenge these barriers.

CMS Proposes 2026 Medicare Telehealth Enhancements Including Behavioral Health and Remote Monitoring

CMS's 2026 Physician Fee Schedule proposal advances Medicare telehealth with expanded behavioral health codes, remote monitoring updates, and virtual Diabetes Prevention Program delivery, shaping long-term digital care integration.

CMS Medicare Learning Network Web-Based Training Supports Provider Education

CMS offers a range of Medicare Learning Network web-based training courses for providers covering billing, coding, fraud prevention, and compliance. Courses are self-paced but do not provide continuing education credits. Subscribe to MLN Connects® for updates.

CMS Expands Medicare Payment Reforms and Medicaid Financing Overhaul

CMS releases 2026 Medicare payment reforms focusing on site-neutral payments, alongside Medicaid financing reforms in the One Big Beautiful Bill and updates on Part D bids influenced by the Inflation Reduction Act.

CMS Launches WISeR Model to Cut Overuse in Medicare with AI-Driven Prior Authorization

CMS introduces the WISeR Model pilot program leveraging AI-driven prior authorization to reduce Medicare overuse and fraud in six states from 2026-2031.