Legislation Targets AI-Based Medicare Prior Authorization Pilot in Washington
U.S. Senators propose legislation to halt CMS AI-powered Medicare prior authorization pilot in six states including Washington due to care delay concerns.
Key Medicare Enrollment Periods and Special Election Windows for 2026
Explore key Medicare enrollment periods for 2026 including the Annual Enrollment Period, Open Enrollment for Advantage Plans, Special Election Periods for new and transitioning beneficiaries, and Medicare Supplement enrollment guidelines.
2027 Medicare Advantage and Part D Proposed Rule: CMS Modernizes Quality Metrics and Risk Adjustment
CMS 2027 Proposed Rule aims to modernize Medicare Advantage and Part D programs with updates to quality metrics, risk adjustment models, and beneficiary protections. Key changes include Star Ratings revisions, incorporation of Inflation Reduction Act drug pricing provisions, and requests for stakeholder feedback on quality bonus payments and care coordination.
Legislation Targets AI-Driven Prior Authorization Pilot in Traditional Medicare
New legislation challenges CMS's AI-driven prior authorization pilot (WISeR) in Traditional Medicare, highlighting concerns over patient access and provider burden.
Most U.S. Adults Satisfied with Health Insurance Despite Coverage Delays
A majority of U.S. adults report satisfaction with health insurance coverage, though 25% have faced denials or delays, according to a new NBC News poll.
2025 Home-Based Care Sector Faces Uncertainty Amid Policy and Market Shifts
Explore key 2025 developments in U.S. home-based care including CMS payment cuts, Medicaid budget impacts, UnitedHealth's Amedisys acquisition, and industry workforce changes shaping provider strategies.
Bipartisan Bill Aims to Expand Medicare ACOs to Include Nurse Practitioners' Care
The ACO Assignment Improvement Act proposes Medicare policy changes to include nurse practitioners and physician assistants in ACO patient assignments, expanding access to coordinated care and supporting Medicare savings and quality improvements.
Medicare Contractors Seek Unified Solution for HGNS Billing Disparities
Medicare Administrative Contractors collaborate on resolving billing inconsistencies for hypoglossal nerve stimulation procedures to standardize reimbursement rates and improve compliance.
CMS Proposes 24 Quality Measures for Medicare Under Annual Review
CMS has published 24 quality and efficiency measures for Medicare programs, emphasizing digital data use and targeting chronic conditions and safety priorities. Public commentary is open through January 6.
CMS Updates on Medicare Drug Price Negotiation and 340B Rebate Litigation
CMS announces changes to Medicare drug price negotiations; ongoing litigation surrounds 340B rebate model and state drug pricing laws, affecting Medicare Advantage plans and Part D reimbursement.