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.
New legislation challenges CMS's AI-driven prior authorization pilot (WISeR) in Traditional Medicare, highlighting concerns over patient access and provider burden.
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.
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.
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 Administrative Contractors collaborate on resolving billing inconsistencies for hypoglossal nerve stimulation procedures to standardize reimbursement rates and improve compliance.
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 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.
CMS and FDA announce ACCESS and TEMPO initiatives to expand technology-enabled care for Medicare beneficiaries with chronic conditions, focusing on outcomes-based payments and regulatory enforcement discretion.
CMS updates Medicare Local Coverage Determinations for skin substitute grafts in 2026, impacting coverage for diabetic foot and venous leg ulcers with evidence-based criteria and new product classifications.
