Policy & Regulatory Changes
Expert articles and analysis related to policy & regulatory changes.
AI Summary — Last 30 Days
CMS is tightening the VBC policy environment on multiple fronts: the Trump administration’s 2027 Medicare Advantage rate and risk-adjustment posture is aimed at narrowing MA’s perceived payment advantage and scrutinizing unsupported diagnoses, while stakeholders are simultaneously pushing CMS to refine mandatory episode-based payment through TEAM and the expanded joint replacement model. Provider groups are positioning for more downside-risk exposure by asking for operational changes to joint replacement and IPPS/LTCH proposals, even as Congress questions CMS’ WISeR prior-authorization pilot—signaling a growing tension between payment integrity, administrative burden, and care redesign. For ACOs, health systems, and payers, the strategic imperative is shifting from model participation alone to infrastructure readiness: data integration, prior authorization automation, risk-coding governance, and episode management capabilities will determine who benefits as CMS expands and polices VBC models (HFMA on MA payment policy; AHA on CMS joint replacement model
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