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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.
Medicare, Telehealth
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.
Social Determinants of Health, Medicare Advantage, Care Delivery Transformation
Member

Senate Deal Reached to End Government Shutdown

Over the weekend, senators reached a deal to reopen the government. The agreement includes a three-bill, full-year spending package for 1) the Department of Agriculture and Food and Drug Administration, 2) the Legislative Branch, and 3) the Defense Department construction projects and the Department of Veterans Affairs, as well as a short-term continuing resolution to extend funding for the rest of the government until Jan. 30, 2026.
Legislation and Legislative Advocacy, Medicaid DSH, Rural issues, Medicare, Telehealth, Hospital at Home, Cybersecurity, Workforce, Medicare Sequestration Payment Reductions
Member

CMS Issues CY 2026 Physician Fee Schedule Final Rule

The Centers for Medicare & Medicaid Services (CMS) Oct. 31 issued a final rule that updates physician fee schedule (PFS) payments for calendar year (CY) 2026.
Physician Fee Schedule (PFS)/MACRA/QPP, Outpatient Prospective Payment Systems (OPPS), Telehealth, Medicare, Ambulatory and Outpatient Care, Behavioral Health Care Delivery, Medicare, Merit-based Incentive Payment System (MIPS), Interoperability, Medicare Physician Payment

KFF analysis highlights limited physician access in Medicare Advantage plans

A new report
Medicare Advantage, Health Insurance

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.
Prior Authorization, Artificial Intelligence (AI), Medicare Advantage

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. 
Medicare, Prospective Payment Systems (PPS), Outpatient Prospective Payment Systems (OPPS), Rural issues, Reducing Healthcare Disparities

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.
Current & Emerging Payment Models, Medicare

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.
Medicare Advantage, Medicaid, Access to Behavioral Health

Medicare open enrollment for 2026 begins

Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7.
Medicare, Enroll in Health Insurance, Medicare Advantage