Insurance News
Regulatory updates in plain English
Stay current with the latest from CMS, state departments of insurance, NAIC, the Federal Register, and Congress — rewritten so you can actually understand what it means for your practice.
CMS Prevents $1.6 Billion in Fraudulent Medicare Laboratory Payments
The Centers for Medicare & Medicaid Services (CMS) has successfully stopped over $1.6 billion in fraudulent payments to Medicare laboratories. This includes the removal of 157 fraudulent lab providers from the Medicare program, which saved $732 million. CMS is using advanced technology, like artific...
CMS News: Trump Administration Announces $35 million to Support Investments in Rapid Response Capabilities to Improve Rural Pennsylvania Healthcare
The Trump Administration has announced a $35 million investment to improve healthcare in rural Pennsylvania. This funding will be used to update medical technology, purchase new equipment, and enhance transportation options for patients. The goal is to provide better healthcare access and outcomes f...
CMS Ends Federal Medicaid and CHIP Funding for Sex-Rejecting Procedures for Children and Youth
The Centers for Medicare & Medicaid Services (CMS) has announced that it will no longer use federal Medicaid and CHIP funds to pay for sex-rejecting procedures for children and youth. This decision affects treatments like puberty blockers, cross-sex hormones, and surgeries, which can have serious lo...
Regulatory Alignment for Predictable and Immediate Device Coverage Pathway (CMS-3487-NC) Procedural Notice Inviting Comment
The Centers for Medicare & Medicaid Services (CMS) has introduced a new process called the RAPID coverage pathway to speed up Medicare coverage for certain medical devices. This change affects manufacturers of Class II and Class III FDA-designated Breakthrough Devices, allowing them to get coverage ...
FY 2027 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule (CMS-1849-F)
On July 31, 2026, the Centers for Medicare & Medicaid Services (CMS) announced new payment rules for hospitals that accept Medicare for the fiscal year 2027. The payment rates for inpatient hospitals will increase by 2.3%, which means hospitals will receive about $2.1 billion more overall. This upda...
CMS News: CMS Announces Nationwide Expansion of Proven Joint Replacement Program
The Centers for Medicare & Medicaid Services (CMS) is expanding a program to improve care for patients undergoing hip, knee, and ankle replacements. Starting January 2028, most hospitals will have to participate in the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, which aims to en...
Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule (CMS-1848-P) — Medicare Shared Savings Program Proposals
The Centers for Medicare & Medicaid Services (CMS) has proposed changes to the Medicare Shared Savings Program for 2027. These changes aim to improve financial incentives for Accountable Care Organizations (ACOs) and encourage participation, especially from those serving higher-risk populations. Key...
CMS Proposes Transformational Medicare Reforms to Expand Accountable Care, Modernize Physician Payment, and Shift from Sick Care to Healthcare
The Centers for Medicare & Medicaid Services (CMS) is making major changes to Medicare that will affect healthcare providers and patients. These reforms aim to make it easier for doctors and hospitals to work together in groups called accountable care organizations (ACOs), which focus on preventing ...
CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement
The Centers for Medicare & Medicaid Services (CMS) is changing how it reviews nursing homes. Starting in September 2026, a new risk-based survey process will focus on high-performing nursing homes, allowing state agencies to use their resources more effectively. This means that better nursing homes ...
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in Guam and the Commonwealth of the Northern Mariana Islands
The Centers for Medicare & Medicaid Services (CMS) has announced new resources and flexibility to help people in Guam and the Northern Mariana Islands affected by Super Typhoon Bavi, which began on July 2, 2026. CMS is providing support to healthcare providers so they can continue to care for those ...
CMS Launches New State Toolkit to Protect Children with Autism, Strengthen Oversight of Applied Behavior Analysis Services
The Centers for Medicare & Medicaid Services (CMS) has introduced a new toolkit to help states improve care for children with autism and ensure that Applied Behavior Analysis (ABA) services are effective and free from fraud. This toolkit aims to protect children by providing states with resources to...
Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F)
On July 30, 2026, the Centers for Medicare & Medicaid Services (CMS) announced new rules for hospice care payments for fiscal year 2027. Medicare hospice payments will increase by 2.3%, which is about $755 million more than the previous year. The new cap for total payments to hospices is set at $36,...
FY 2027 Inpatient Rehabilitation Facilities (IRF) Prospective Payment System (PPS) Final Rule (CMS-1845-F)
The Centers for Medicare & Medicaid Services (CMS) has updated the payment rates for inpatient rehabilitation facilities (IRFs) for fiscal year 2027. The payment rates will increase by 2.3%, which is based on a market basket increase of 3.2% minus a productivity adjustment. This change will result i...
Fiscal Year 2027 Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1843-F)
The Centers for Medicare & Medicaid Services (CMS) has updated payment rules for skilled nursing facilities for fiscal year 2027. Payments will increase by 2.4%, which means an additional $882.74 million will be distributed to these facilities. Additionally, two COVID-19 related quality measures wil...
Fiscal Year 2027 Medicare Inpatient Psychiatric Facility Prospective Payment System Final Rule (CMS-1847-F)
The Centers for Medicare & Medicaid Services (CMS) has updated the payment rules for Inpatient Psychiatric Facilities (IPFs) for the fiscal year 2027. Payments will increase by 2.3%, which translates to an additional $60 million for IPFs compared to the previous year. Starting in fiscal year 2028, t...
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in the State of Washington
The Centers for Medicare & Medicaid Services (CMS) has announced new resources and flexibilities to help residents in Washington state affected by wildfires. This includes support for healthcare providers to ensure they can continue offering care during the ongoing public health emergency declared o...
Calendar Year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule (CMS-1850-P)
On July 2, 2026, the Centers for Medicare & Medicaid Services (CMS) proposed new payment rules for hospital outpatient services and Ambulatory Surgical Centers (ASCs) for the year 2027. This change will impact around 3,500 hospitals and 6,400 ASCs. The proposed updates include a 2.4% increase in pay...
CMS Acts to Strengthen Care Quality, Cut Drug Costs, and Slash Out-of-Pocket Expenses for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) has announced changes to how Medicare pays for outpatient care, which will start in 2027. These changes aim to lower drug costs and out-of-pocket expenses for Medicare beneficiaries. CMS plans to adjust payment rates for drugs purchased under the 34...