Policy & Regulatory Changes
Expert articles and analysis related to policy & regulatory changes.
AI Summary — Last 30 Days
CMS is signaling a more assertive Trump-era CMMI agenda that pairs mandatory or scalable payment reform with technology-enabled chronic care management: the CJR model’s reported $180M in savings is strengthening the case for broader bundled-payment expansion, while CMS’ ACCESS expansion adds heart failure, COPD, substance use disorders, and tobacco use for Spring 2027, pushing providers toward longitudinal, data-driven population health infrastructure. At the same time, CMS’ finalized GLOBE drug pricing model and ACCESS model activity suggest RFK Jr.’s HHS, Dr. Oz’s CMS, and Abe Sutton’s CMMI are positioning affordability, specialty-drug spend, and chronic disease management as central VBC levers. Medicare Advantage remains a parallel pressure point: star ratings are moving markets and litigation risk, while DOJ/OIG activity against MA coding practices reinforces that risk adjustment, quality scoring, and compliance discipline are becoming core strategic capabilities for payers and risk-bearing providers.
Related Articles
CMS REFOCUSES MEDICAID QUALITY ON HEALTH OUTCOMES, LAUNCHES INNOVATIVE PARTNERSHIP WITH 37 STATES
CMS REFOCUSES MEDICAID QUALITY ON HEALTH OUTCOMES, LAUNCHES INNOVATIVE PARTNERSHIP WITH 37 STATES InsuranceNewsNet
CMS guidance details how states can apply the Medicaid medical frailty exemption
New guidance from CMS explains how states can operationalize the medical frailty exemption to the Medicaid work requirement. Per the guidance, the intent is for states to identify medically frail bene...
Medicaid tax rule goes beyond the statute, say hospitals
A proposed rule to implement provider tax provisions of the 2025 Medicaid overhaul would be far more restrictive than that law required, say hospital advocates. Hospitals raised those concerns in resp...
CMS Expands ACCESS Model: Heart Failure, COPD, SUDs & Tobacco Added for Spring 2027
CMS Expands ACCESS Model: Heart Failure, COPD, SUDs & Tobacco Added for Spring 2027 Crowell & Moring LLP
CMS and 37 States Pledge to Judge Medicaid Care by Whether Patients Get Healthier, Not Paperwork Checklists
CMS and 37 States Pledge to Judge Medicaid Care by Whether Patients Get Healthier, Not Paperwork Checklists Medical Daily
MedPAC Chair Defends $76 Billion Medicare Advantage Overpayment Estimate as Insurers Push Congress to Change the Math
MedPAC Chair Defends $76 Billion Medicare Advantage Overpayment Estimate as Insurers Push Congress to Change the Math Medical Daily
Early Medicaid Work Requirement Insights From Nebraska
This brief describes the verification process for Medicaid work requirements in Nebraska and examines early data on outcomes for individuals subject to work requirements.
CMS finalizes model that aims to bring most-favored nation pricing to Part B
CMS finalizes model that aims to bring most-favored nation pricing to Part B Fierce Healthcare
Employers increasingly tie digital health payments to outcomes, PHTI survey finds
Employers increasingly tie digital health payments to outcomes, PHTI survey finds Fierce Healthcare