Policy & Regulatory Changes
Expert articles and analysis related to policy & regulatory changes.
AI Summary — Last 7 Days
Medicare Advantage policy volatility is intensifying as Centene sued HHS and CMS over 2027 Star Ratings, seeking roughly $448M tied to rules a court had already rejected—raising near-term uncertainty for MA quality bonuses, plan bids, and provider contracts tied to Stars performance (Centene Star Ratings lawsuit). At the same time, UnitedHealthcare and Humana MA exits affecting about 1 million members and criticism of CMS’ WISeR prior-authorization program underscore mounting friction between affordability controls, beneficiary access, and delegated-risk operations. For ACOs and health systems, the signal is a continued federal shift under the Trump administration toward harder-edged performance accountability, with stakeholders preparing for more mandatory risk models while ACO advocates press CMS not to leave high-cost populations such as kidney-care patients outside Medicare payment reform.
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