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News

CMS releases update on post-shutdown provider claims

The Centers for Medicare & Medicaid Services released an updated notice Nov. 20 on the processing of Medicare provider claims impacted by the government shutdown.
News

CMS releases details on Medicare premiums, deductibles for 2026

The Medicare Part A deductible for inpatient hospital services will increase by $60 in calendar year 2026 to $1,736, the Centers for Medicare & Medicaid Services
News

Government shutdown ends as President Trump signs funding bill into law  

The 43-day government shutdown ended late Nov. 12 when President Trump signed a funding bill into law, hours after the House passed the measure by a 222-209 vote.
Insights and Analysis
Member

Voices on Value: A Conversation with William Shrank, M.D.

Priya Bathija, vice president of AHA’s The Value Initiative, talks with William Shrank, M.D., senior vice president and chief medical officer, Humana, to get his insights on health care affordability, value and the strategies that Humana is using to disrupt health care delivery.
News

AHA shares concerns, recommendations with CMS on WISeR model

The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address multiple concerns.
News

CMS proposes increasing payment rates by 2.6% in CY 2025 

The Centers for Medicare & Medicaid Services July 10 issued a proposed rule that would increase Medicare hospital outpatient prospective payment system rates by a net 2.6% in calendar year 2025 compared to 2024. This includes a proposed 3.0% market basket update, offset by a 0.4 percentage point cut for productivity. 
News

CMS releases guide on prior authorization submissions, determinations under WISeR model  

The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and Inappropriate Service Reduction model.
News

OIG says MA, Medicaid managed care plans have limited, inaccurate behavioral health provider networks 

A report by the Department of Health and Human Services Office of the Inspector General found that many Medicare Advantage and Medicaid managed care plans offer access to a limited proportion of behavioral health providers, and inaccurately list 72% of in-network behavioral health care providers as being available.
News

Medicare open enrollment for 2026 begins

Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7.