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 News: Trump Administration Announces $32 Million to Recruit Rural Doctors, Train Healthcare Workers and Expand Emergency Mental Healthcare Across Mississippi
The Trump Administration has announced a $32 million investment to improve healthcare in rural Mississippi. This funding will help recruit doctors, train healthcare workers, and set up three emergency mental health units. The goal is to ensure that rural communities have access to quality healthcare...
CMS Proposes Reforms to Strengthen Transparency and Affordability in Medicare Advantage and Part D
The Centers for Medicare & Medicaid Services (CMS) has proposed new rules to improve Medicare Advantage and Part D. These changes will make provider directories more accurate, require Pharmacy Benefit Managers (PBMs) to be transparent about their compensation, and protect low-income Medicare benefic...
Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026 (CMS-4214-P)
The Centers for Medicare & Medicaid Services (CMS) has proposed new rules that will affect Medicare Advantage and Medicare Part D programs starting in 2028. Key changes include eliminating the $1 copayment for generic drugs for low-income individuals who are fully eligible for both Medicare and Medi...
CMS News: Trump Administration Announces $78 Million for Rural Healthcare Workforce, Chronic Disease Prevention, and Facility Upgrades Across Texas
The Trump Administration has announced a $78 million investment aimed at improving healthcare in rural Texas. This funding will go to 216 rural healthcare providers to help them recruit and retain medical staff, upgrade outdated equipment, and focus on preventing chronic diseases like diabetes and h...
Transparency in Coverage Final Rules (CMS 9882-F)
The Department of Health and Human Services has updated the Transparency in Coverage rules to make healthcare pricing information easier to access and understand. Starting October 5, 2026, health plans and insurers must provide clearer and more standardized pricing data for their services. This is a...
CMS Convenes Certified Independent Dispute Resolution Entity Leaders to Discuss Ways to Improve the Federal Program
On October 1, 2026, the Centers for Medicare & Medicaid Services (CMS) held a meeting with leaders from certified independent dispute resolution (IDR) entities to discuss improvements to the federal IDR process. This process helps resolve disputes about out-of-network medical bills, protecting patie...
CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
The Centers for Medicare & Medicaid Services (CMS) has announced a new program called the GLOBE Model, which aims to lower drug prices for Medicare Part B beneficiaries. This program will test a new way to calculate rebates for certain drugs, using prices from other countries as a benchmark. The goa...
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in Alabama and Florida
The Centers for Medicare & Medicaid Services (CMS) has announced new resources and flexibilities for healthcare providers in Alabama and Florida due to a Public Health Emergency caused by Hurricane Isaias. This emergency status begins on October 6 and 7, 2026, respectively. CMS is working with state...
CMS News: Trump Administration Announces $78 Million for Rural Healthcare Workforce, Chronic Disease Prevention, and Facility Upgrades Across Texas
The Trump Administration has announced a $78 million funding boost to improve healthcare in rural Texas. This money will go to 216 rural healthcare providers to help recruit and keep healthcare workers, upgrade medical facilities, and focus on preventing chronic diseases like diabetes and heart dise...
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 Cracks Down on Fraud, Waste, and Abuse in the Federal Health Insurance Marketplace®
The Centers for Medicare & Medicaid Services (CMS) is taking strong action to combat fraud in the Federal Health Insurance Marketplace. They are canceling about 315,000 unauthorized enrollments, affecting over 760,000 individuals, which will help recover around $2.2 billion in taxpayer-funded subsid...
CMS Announces New Preliminary Medicare Payment Rates for Laboratory Services, Saving Taxpayers an Estimated $1 Billion Annually
The Centers for Medicare & Medicaid Services (CMS) has announced plans to change the payment rates for laboratory services under Medicare. Starting in 2027, these rates will be more closely aligned with what private insurers pay, which is expected to save taxpayers about $1 billion each year. Curren...
CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic Conditions
Starting in Spring 2027, Medicare will offer new options to help people with chronic conditions like heart failure, COPD, substance use disorders, and nicotine dependence. This initiative, called the ACCESS Model, will allow Medicare beneficiaries to receive ongoing care from home, using technology ...
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, SBA, and Georgia Recognize Innovative CHOICE Arrangements as Major Win for Small Businesses
The Centers for Medicare & Medicaid Services (CMS) and the U.S. Small Business Administration (SBA) have introduced CHOICE Arrangements, a new option for small businesses to provide health benefits at a lower cost compared to traditional group insurance. This program allows employers to set a fixed ...
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...