CMS has created an office focused on rural health transformation initiatives. The Office of Rural Health Transformation will oversee the $50 billion Rural Health Transformation Program, according to an announcement published in the Federal Register. The program aims to improve…
Payer
CMS is seeking input on whether its risk adjustment system disadvantages smaller Medicare Advantage plans, and one regional plan CEO says the answer is an emphatic yes. In its 2027 proposed MA rule, CMS said it recognizes the current risk…
The Louisiana Department of Health is extending UnitedHealthcare’s Medicaid contract through March 31, the insurer confirmed to Becker’s in a Dec. 18 statement. The state previously decided to cut the contract, which would have expired Dec. 31, thanks to an…
CMS is terminating its Medicare Advantage contract with American Health Plan of Texas after the insurer failed to meet minimum quality standards for three consecutive years. The agency issued a notice of termination Dec. 17 to the Franklin, Tenn.-based company,…
Facing a shifting regulatory landscape and provider tensions, some insurers have reached a crossroads with Medicare Advantage. This year proved pivotal in shaping how payers would move forward. Here are the 3 biggest trends from the year: 1. Coding intensity…
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CMS is launching its long-term enhanced accountable care organization design, or LEAD, model at the end of 2026, following the conclusion of the ACO realizing equity, access and community health model. Previously, CMS set a goal to have all traditional…
Minnesota is rehabilitating UCare, according to a Dec. 17 court filing. The state will take over the insurer’s assets and finances. While providers cannot collect payment from UCare during this time, provider contracts could be modified under the state’s supervision.…
Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025:
CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo. After the pilot, the agency expects to expand the data-collection efforts to all…
Humana’s Louisiana business received at least $10.5 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit report from HHS’ Office of Inspector General. The audit, published in December, reviewed high-risk diagnosis codes including acute stroke, acute…