On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1834-P],...more
7/18/2025
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Financial Services Industry ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Payment Systems ,
Proposed Rules ,
Regulatory Requirements ,
Reporting Requirements
Health plan members of AHIP and the Blue Cross and Blue Shield Association made news earlier this week when they announced a series of steps that a broad swath of health insurers will take to improve the prior authorization...more
6/26/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Insurance Industry ,
Medicare Advantage ,
New Regulations ,
Prior Authorization ,
Regulatory Reform ,
Regulatory Requirements
While much of Washington, DC’s attention this week has been focused on congressional action around budget reconciliation, including proposed changes to the Medicaid program, the White House also made news with release of a...more
This past week, the Trump administration put its first major stamp on the Medicare Advantage (MA) program. The Centers for Medicare & Medicaid Services (CMS) released two final regulatory documents related to MA:
- The...more
4/10/2025
/ Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Final Rules ,
Healthcare ,
Healthcare Reform ,
Inflation Reduction Act (IRA) ,
Medicare Advantage ,
Medicare Part D ,
Pharmaceutical Industry ,
Prescription Drugs ,
Regulatory Requirements ,
Risk Management ,
Rulemaking Process ,
Technology Sector
Key Takeaways -
- CMS is expected to issue the 2026 final rate notice for Medicare Advantage (MA) and Part D plans by April 7, 2025.
- The January 2025 advance notice proposed policies that would increase payments to MA...more
Last week, the contract year (CY) 2026 Medicare Advantage (MA) and Part D final reg entered the clearance process at the Office of Management and Budget (OMB). As mentioned in a previous Regs & Eggs blog post, OMB’s review is...more
3/13/2025
/ Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Inflation Reduction Act (IRA) ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
Medicare Payment Reform ,
Mental Health ,
OMB ,
Pharmaceutical Industry ,
Prescription Drugs ,
Prior Authorization ,
Proposed Rules ,
Technology ,
Utilization Review
The Trump administration will have its own vision on value-based care, creating specific priorities for the Center for Medicare & Medicaid Innovation (CMMI), the federal government’s primary testing ground for payment and...more
2/26/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Trump Administration ,
Value-Based Care ,
Value-Based Payments
A few weeks ago, Regs & Eggs provided insights into Medicare Advantage (MA), the private insurance option under Medicare, and explored both short- and long-term actions that the Trump administration could take to modify MA...more
2/13/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Insurance Industry ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
Proposed Rules ,
Regulatory Agenda ,
Trump Administration