CMS has finalized a 2.6% payment increase for inpatient services, boosted DSH payments, established new interoperability rules for prior authorization, and confirmed the launch of a controversial ...

As of February, a share of payers and providers had not yet started working toward the application programming interface requirements established by CMS’ interoperability and prior authorization final ...

CMS finalizes ACA marketplace overhaul for 2027, updating plan design, eligibility verification, and subsidy qualifications for insurers and enrollees.

A large portion of payers and providers have not started or are partially through implementing CMS API requirements, with compliance due by January 1, 2027. Key challenges include funding, developing ...

A new CMS final rule increases IPPS payment rates by 2.6% for 2026 and finalizes several key policy changes, including the launch of a mandatory bundled payment model, new e-prescribing standards, and ...

The Centers for Medicare & Medicaid Services May 13 announced 30 health care organizations have pledged early participation in its electronic prior authorization initiative.

The days of faxed forms and days-long waits for prior authorization approvals are officially ending under the new CMS 2026 rules. With the Interoperability and Prior Authorization Final Rule now in ...

CMS has proposed a 2026 rule expanding prior authorization reforms to include drugs under both medical and pharmacy benefits, introducing electronic workflows, faster decision timelines, and greater ...

On April 14, 2026, the Centers for Medicare and Medicaid Services (“CMS”) published a proposed rule[1] that would require faster prior authorization (“PA”) decisions, expand electronic PA to drugs, ...

On April 10, 2026 (and officially published in the Federal Register on April 14, 2026), CMS published a proposed rule that would expand electronic prior authorization requirements, modernize HIPAA ...

Healthcare and technology groups want Medicare Advantage plans included in the Centers for Medicare and Medicaid Services' proposed rule to expand access to health information and improve the prior ...