CMS & CMMI Updates
Stay current with CMS Innovation Center models, news, and regulatory updates
CMS Intelligence Summary
Key Actions:
- Interoperability & Prior Authorization: CMS released the 2026 Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P), proposing enhanced requirements for electronic prior authorization processes and expanded data exchange among payers using payer-to-payer API workflows. The rule targets improved care coordination, reduced administrative burden, and streamlined pharmacy benefit operations. Overview of the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P), Payer-To-Payer Application Programming Interface Workflow.
Key Actions:
- Interoperability & Prior Authorization: CMS released the 2026 Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P), proposing enhanced requirements for electronic prior authorization processes and expanded data exchange among payers using payer-to-payer API workflows. The rule targets improved care coordination, reduced administrative burden, and streamlined pharmacy benefit operations. Overview of the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P), Payer-To-Payer Application Programming Interface Workflow.
- Program Integrity: Significant enforcement actions reflect ongoing OIG and CMS scrutiny on fraud and abuse:
- Multiple high-dollar settlements under the Civil Monetary Penalties Law (e.g., Choice HomeCare: $34.9M, Mercy Medical Center: $14.8M, Cancer Center Oncology Medical Group: $429K) for improper billing and remuneration. Choice HomeCare Settlement, Mercy Medical Center Settlement.
- Criminal charges and sentencing in high-profile fraud cases: [Former Teacher](https://news.google.com/rss/articles/CBMi6gFBVV95cUxOR3Qy
Register free to keep reading
Register free to access AI-powered government policy summaries and analysis. Plus get 30 days of Pro access free.
Includes 30 days of Pro access free
Recent Publications
- ACRB_905_Positions.pdfCMS.gov· Apr 18, 2026
- Advisory Opinion 26-07 - OIGCMS.gov· Apr 18, 2026
- Overview of the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P)CMS.gov· Apr 17, 2026
- CMS Manual SystemCMS.gov· Apr 17, 2026
- Advisory Opinion 26-07CMS.gov· Apr 17, 2026
- Register free to access publication links →
Fed Watch
Key leaders & interviews
Webinars & Events
Community Discussion
Want to discuss this briefing with other professionals?
Sign in to Start Discussion