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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.
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.
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.
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.
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 open enrollment for 2026 begins
Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7.
Health Plan Accountability Update: October 2025
The AHA May 29 submitted a letter to the Centers for Medicare & Medicaid Services responding to a request for information regarding Medicare Advantage data, urging CMS to increase oversight of the program.
AHA encourages MedPAC to refine analysis of MA enrollment impacts on patients, providers
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on hospitals, which found that increased enrollment is not statistically associated, on average, with all-payer hospital margins.
AHA Comments on MedPAC Analysis of MA Enrollment Changes
AHA comments on the Medicare Payment Advisory Commission’s preliminary analysis of the association between Medicare Advantage (MA) enrollment changes and hospital finances shared during the September public meeting.