CMS announced a nationwide six-month enrollment moratorium for hospice and home health agencies, signaling expanded utilization oversight, fraud prevention efforts, and increased scrutiny of prior authorization, claims review, and post-acute care management practices across the payer industry.
CMS finalized a new rule requiring electronic claims attachments, with compliance required by May 2028 and significant projected cost savings.
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 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.
Industry Watch Alert Home The Centers for Medicare & Medicaid Services announced it is extending the application deadline for prescription drug manufacturers to participate in
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 regulations focused on lowering premiums, expanding plan flexibility, and strengthening subsidy oversight and program integrity for payers.
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.
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.
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.
