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A paper by Mark Shepard and Jacob Wallace (2026) has a great overview of the Medicaid managed care program. The first question one may have is, how does Medicaid managed care diffe...
On June 3, 2026, CMS issued an Interim Final Rule titled “Medicaid Program; Community Engagement Requirement for Certain Individuals” (Interim Final Rule) establishing federal para...
National 4 healthcare laws, rules taking effect July 1 AHA urges CMS to reconsider its LTCH payment schedule AHA recommends changes to CMS’ mandatory payment model for joint replac...
In two recent civil antitrust complaints, the Antitrust Division of the U.S. Department of Justice (“DOJ”) alleged that hospital systems used payer contracting provisions—so‑called...
On May 27, 2026, Connecticut Governor Ned Lamont signed “An Act Concerning Return of Health Care Provider Payments” (PA 26-56). As of January 1, 2027, PA 26-56 shortens the time pe...
National 20 largest healthcare data breaches reported in 2026 so far 4 healthcare laws, rules taking effect July 1 26 states sue CMS over final Medicaid work requirements rule AHA...
Eight-month payer IT study recognizes top client-scored achievement in one of managed care's highest-return operating categories as health plans tighten 2026-2027 vendor selection...
NATIONAL After FDA commissioner departure, drug center head is out AHA Statement on House Health Subcommittee Hearing Examining Physician Fees, Payment Reforms AMA taps new COO fro...
National 17 health systems affected by Oracle Health data breach CMS proposes to slash 340B payments to hospitals CMS scraps ‘fast-track’ process for certain Medicaid waivers: 6 th...
THIS WEEK’S DOSE Senate Democrats request information on reforming drug pricing. The request for information focuses on lowering prescription drug pricing and out-of-pocket costs...
National 7 CMS rules and policy updates to know in 2026 Agencies issue proposed rule codifying Medicare Drug Price Negotiation Program AHA calls for improvements to FY 2027 payment...
States must rethink how program integrity is designed and delivered by focusing on four key priorities that enable oversight to scale alongside these programs. The post Modernizing...
NATIONAL 6 unique Rural Health Transformation fund proposals 5 Stark law cases disrupting physician compensation structures After nurses, PA groups sue over ‘professional degree’ l...
National 1.4 million patients, 7 health systems caught in AI company data breach 4 hospital groups call for federal action as Eli Lilly strips 340B discounts AHA files amicus brief...
Key Takeaways CMS is set to launch the WISeR gold-carding exemption program on July 6 in Washington state, with quarterly rollouts to the other five WISeR states to follow. Provid...
California’s Attorney General has announced another CPOM enforcement settlement, this time requiring Carbon Health to unwind and restructure core elements of its friendly‑PC model....
Insurers reject one in 12 claims and pay 71 paise per rupee claimed. The managed care model promises to fix that. Here is what it solves and what it quietly relocates.
Independent Category-Specific KPI Polling Recognizes Client-Reported Performance Across Member Stratification, Care Planning, Clinical Tasking, Care-Team Workflow, Transitions of C...
The Centers for Medicare & Medicaid Services’ (“CMS’s”) guidance governing Medicare Advantage marketing practices has continued to evolve over the past several years, with regu...
The PBM industry continues to evolve through legislative action, litigation, and voluntary industry changes. Below is a brief round-up of recent developments including new federal...
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