CMS Claims Attachment Final Rule Announced in High-Demand Town Hall
March 31, 2026
CMS finalized a new rule requiring electronic claims attachments, with compliance required by May 2028 and significant projected cost savings.
CMS Prior Authorization Public Reporting Deadline Arrives March 31
March 19, 2026
By March 31, 2026, impacted payers must publicly post prior authorization metrics for calendar year 2025 under CMS-0057-F. That includes data tied to approval and denial rates, appeal outcomes, turnaround times, and the items and services subject to prior authorization.
CMS Strengthens Patient Protections in Organ Donation System
March 12, 2026
CMS has issued new guidance strengthening patient protections and accountability in the organ donation system, with implications for payers around transplant network oversight, OPO recertification, and member care navigation through 2027.
Centers for Medicare & Medicaid Services Extends Manufacturer Application Window for GENEROUS Model
March 4, 2026
Industry Watch Alert Home The Centers for Medicare & Medicaid Services announced it is extending the application deadline for prescription drug manufacturers to participate in
Trump Administration Announces Major Fraud Prevention Actions Across Medicare and Medicaid
February 26, 2026
The Trump Administration announced expanded fraud prevention actions across Medicare and Medicaid, signaling a shift toward real-time oversight, increased transparency, and heightened program integrity expectations for payer organizations.
CMS Proposes 2027 Exchange Rules Focused on Cost Control, Plan Flexibility, and Program Integrity
February 12, 2026
CMS proposes 2027 Exchange regulations focused on lowering premiums, expanding plan flexibility, and strengthening subsidy oversight and program integrity for payers.
Consolidated Appropriations Act, 2026 (H.R. 7148) Signed Into Law
February 4, 2026
The Consolidated Appropriations Act, 2026 extends Medicare telehealth and hospital-at-home programs while delaying Medicaid DSH cuts, reinforcing long-term oversight and utilization management considerations for healthcare payers.
What the “Great Healthcare Plan” Announcement Means for Healthcare Executives
February 3, 2026
An executive analysis of the White House Great Healthcare Plan proposal, what it could mean for payers and providers, current congressional status, and realistic timelines for potential healthcare policy changes.
Trump Administration Launches Great American Recovery Initiative: Key Signals for Healthcare Payers and Addiction Treatment
January 30, 2026
A new White House initiative coordinates federal agencies, funding, and data-driven goals to expand addiction treatment and recovery, with key signals for healthcare payers.
Agentic Clinical AI and the Future of Cardiovascular Care: Strategic Signals for Payers
January 22, 2026
The recent ARPA-H announcement outlining the ADVOCATE initiative signals a medium-to-high strategic impact for payers over the next 3–7 years.