Policy & Regulatory Changes
Expert articles and analysis related to policy & regulatory changes.
AI Summary — Last 7 Days
CMS policy activity this week shows the Trump administration tightening VBC model accountability while drawing pushback over operational burden: AHA urged changes to CMS’ mandatory FY 2027 Joint Replacement Expanded Model, signaling provider concern that mandatory episode-based payment expansion could expose hospitals to risk without sufficient risk adjustment, exclusions, or infrastructure support (AHA comments). At the same time, congressional scrutiny of CMS’ WISeR pilot and CMS moves to enforce stricter Medicaid Section 1115 waiver budget neutrality point to a broader shift toward utilization oversight, fiscal discipline, and tighter evidence standards—creating new compliance and care-management pressures for ACOs, MA plans, Medicaid managed care organizations, and providers.
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CMS Proposes Restrictive Definition Of Medical Frailty In New Medicaid Work Requirements Rule - open minds
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The Myth of Insurance Networks
How America’s outdated insurance model is failing at its most important job The post The Myth of Insurance Networks appeared first on MedCity News.
CMS Releases Interim Final Rule on Medicaid Work Reporting Requirements
CMS Releases Interim Final Rule on Medicaid Work Reporting Requirements  State Health and Value Strategies
Over half of Medicaid enrollees say they’re unaware of upcoming work requirements
Many enrollees don’t know they’ll need to report work, education or volunteer hours starting in less than six months in order to stay covered, according to a recent survey from the Health Management A...