CMS finalizes the mandatory Ambulatory Specialty Model in Medicare, expanding value-based care to specialists treating chronic conditions with two-sided financial risk and collaborative care requirements.

CMS initiates the WISeR Model in six states to employ AI-driven prior authorization, targeting reduced low-value services and Medicare spending under traditional fee-for-service programs.

Clear wins CMS contract to implement Clear1 biometric identity platform for Medicare.gov, enhancing secure, seamless access for Medicare beneficiaries.

CMS proposes expanded 2027 Medicare Advantage benefits to include FDA-approved hemp products as supplemental coverage for chronically ill enrollees, following federal and state hemp regulations.

The Centers for Medicare and Medicaid Services (CMS) indefinitely suspends mandatory skilled nursing facility off-cycle enrollment revalidation, addressing provider challenges and ensuring continuity of care. Key insights on regulatory impact and industry response.

CMS and FDA introduce ACCESS and TEMPO models to enable digital health device integration in traditional Medicare, focusing on outcome-aligned payments, regulatory easing, and expanded patient access.

Former CMS Administrator Thomas Scully discusses Medicare Advantage expansion, risk adjustment challenges, healthcare quality improvements, and the impact of bipartisan politics on U.S. healthcare policy.

The GAO 2025 report reveals persistent fraud in ACA enrollments with unauthorized plan changes despite new CMS federal rules, urging stronger verification for insurance marketplaces.

GAO report reveals ongoing unauthorized plan switching and enrollment fraud in ACA marketplaces in 2024, exposing regulatory shortcomings and CMS challenges.

The GAO's 2025 report highlights ongoing enrollment fraud and identity verification weaknesses in the ACA marketplaces, stressing the need for stronger anti-fraud measures and legislative action.