Search results for Medicare Approvals

Medicare’s 72-Hour Decision Rule Begins Now: What Seniors Must Know About Faster Approvals and Denials

Millions of seniors enrolled in Medicare Advantage plans have spent years frustrated by delayed prior authorization decisions for medical care, scans, procedures, and treatments. S...

CMS finalizes policy and technical changes to Medicare, MA, Part D for CY 2027 

The Centers for Medicare & Medicaid Services April 2 released a final rule on policy and technical changes to Medicare Advantage, the Medicare Prescription Drug Benefit Pro...

Medicare Advantage Prior‑Authorization Denials Jumped 56% — New April Rules Aim to Fix It

If you’ve ever had a doctor recommend a treatment—only to be told you need “approval first”—you’ve experienced prior authorization. For millions of seniors on Medicare...

CMS announces electronic prior authorization initiative

The Centers for Medicare & Medicaid Services yesterday announced a new electronic prior authorization initiative as part of its Health Technology Ecosystem. CMS Administrat...

AI-powered prior authorizations for Medicare have greatly delayed care, Washington state hospitals say

The Centers for Medicare & Medicaid Services' experimental WISeR Model has Medicare patients waiting two to four times longer for procedures, according to a Washington senators...

CMS’s New AI-Powered Prior Authorization System: Will It Speed Up Approvals or Deny Seniors Critical Care?

For years, seniors and doctors have complained that prior authorization delays can feel like a second illness layered on top of an existing medical problem....

CMS to provide Medicare Part D beneficiaries with $50 monthly access to certain GLP-1 medications

The Centers for Medicare & Medicaid Services announced May 6 that it will provide access to certain glucagon-like peptide-1 (GLP-1) medications to eligible Medicare Part D...

CMS announces first 29 health care organizations to join electronic prior authorization initiative

The Centers for Medicare & Medicaid Services May 13 announced 29 health care organizations have pledged early participation in its electronic prior authorization initiative...

Trump admin freezes some new Medicare enrollments in 'fraud-preventing' move

The moratorium will temporarily stop all new providers in these categories from signing up for reimbursement from Medicare, the federal insurance program for older adults across th...

CMS releases proposed rule establishing electronic standards for drug prior authorizations

The Centers for Medicare & Medicaid Services April 10 released a proposed rule that would establish electronic standards for drug prior authorizations. Building on a 2024 f...

CMS, FDA announce pathway to expedite access to certain medical devices for Medicare beneficiaries

The Centers for Medicare & Medicaid Services and the Food and Drug Administration April 23 announced a new pathway to expedite access to certain FDA-designated Class II and...

New Plan Could Speed Medicare Coverage for Innovative Devices

FRIDAY, April 24, 2026 — A new proposal could make it easier for patients to access breakthrough medical devices through Medicare. On Thursday, federal regulators announced a plan...

Strengthening Medicare Advantage to Better Serve Today’s Seniors

Approximately 35 million Americans are enrolled in Medicare Advantage plans in 2026, and that number is expected to grow to about 45 million MA enrollees by 2030. That means within...

CMS finalizes Medicare Advantage rates for CY 2027

The Centers for Medicare & Medicaid Services April 6 released the Medicare Advantage and Part D Rate Announcement for calendar year 2027. The rate announcement finalized a...

Moratorium on New Medicare Enrollment

CMS is imposing a six-month nationwide moratorium on new Medicare enrollment for hospices and home health agencies in a sweeping effort to combat fraud. Effective immediately, CMS...

Empirical Health to deliver proactive cardiovascular care as part of Medicare's new ACCESS program

New initiative brings proactive, data-driven heart health support to individuals with elevated blood pressure, cholesterol, A1c, or BMI on Medicare. NEW YORK, April 16, 2026 /PRNew...

AHA comments on proposed changes to Medicare Advantage, Part D data reporting requirements

The AHA today submitted comments on the Centers for Medicare & Medicaid Services’ proposed revisions to Medicare Advantage and Part D reporting requirements for contract ye...

Federal government demands renewal for every healthcare provider that receives Medicaid

Medicaid Provider Revalidation: Navigating Dr. Oz’s Sweeping Enrollment Audit

On April 23, 2026, Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (“CMS”), sent letters to all governors and State Medicaid Directors requesting t...

CMS Announces Nationwide Moratoria on Medicare Enrollment of Home Health Agencies

As part of an effort to crack down on publicized fraud, the Centers for Medicare and Medicaid Services (CMS) announced on May 13, 2026, a nationwide moratoria on new Medicare enrol...

Trump admin freezes some new Medicare enrollments in 'fraud-preventing' move

The moratorium will temporarily stop all new providers in these categories from signing up for reimbursement from Medicare, the federal insurance program for older adults across th...

CMS accepts more than 150 organizations for participation in ACCESS Model, extends application deadline

The Centers for Medicare & Medicaid Services April 13 announced that more than 150 organizations have been accepted to participate in the launch of its Advancing Chronic Ca...

AHA expresses support for comprehensive bill on Medicare Advantage reform

The AHA May 7 wrote to House and Senate lawmakers in support of the Medicare Advantage Improvement Act (H.R. 8375/S. 4384), bipartisan and bicameral legislation that offers compreh...

OIG Approves Medicare Advantage EGWP Gainshare Payments to Employer Groups

Highlights The Office of Inspector General (OIG) issued a favorable opinion regarding a proposal by an entity and its Medicare Advantage (MA) subsidiaries that offer Employer G...