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CMS issues updated guidance on state-directed payment provision
The Centers for Medicare & Medicaid Services Feb. 2 revised its approach to determining grandfathering eligibility by redefining the 180‑day window around July 4, 2025, to be calculated using business days.
HHS announces behavioral health program to assist homeless individuals
The Department of Health and Human Services today announced a new behavioral health
Survey finds prior authorization viewed as greatest hurdle in navigating health care
A KFF survey published today found that peopl
Department of Labor releases proposed rule on transparency of PBM fee disclosures
The Department of Labor has issued a proposed rule to improve transparency of fees collected by pharmacy benefit managers.
CMS finalizes changes to Medicaid provider tax waiver rules
The Centers for Medicare & Medicaid Services Jan. 29 issued a final rule regarding states non-uniform or non-broad-based provider tax, as authorized under special waivers.
HHS OIG releases bulletin on direct-to-consumer drug sales, RFI on need for regulatory changes
The Department of Health and Human Services Office of Inspector General Jan. 27 released a bulletin addressing how direct-to-consumer drug programs can sell prescription drugs to patients with federal health care program coverage at lower costs without violating the Anti-Kickback Statute.
CMS announces drugs selected for third round of drug price negotiations
The Centers for Medicare & Medicaid Services Jan. 27 announced 15 drugs under Medicare Parts D and B selected for the third round of price negotiations.
Analysis: MA insurers made 53 million prior authorization determinations in 2024
A KFF analysis released Jan. 28 found that Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, an increase from 49.8 million in 2023.
White paper explains use of mock claims for advanced explanation of benefits
The AHA Jan. 26 released a white paper on addressing challenges in implementing an advanced explanation of benefits, which requires coordination among multiple providers, health plans and IT systems.
SAMHSA releases guide to strengthen coordination between 988 lifeline, 911 services
The Substance Abuse and Mental Health Services Administration has released a guide to improve coordination between 988 lifeline and 911 emergency services.