Proposed Changes to the Medicare Diabetes Prevention Program
CMS proposed changes will expand reach of the Medicare Diabetes Prevention Program (MDPP) to achieve MAHA goals. Deadline to comment is 9/12/2025.
Read MoreRegulatory Issues
A New Set of Indices to Measure Hospital Interoperability Progress
By Catherine Strawley & Jordan Everson – What’s in a number? A lot, it turns out, especially when it comes to measuring interoperability progress. For well over a decade, we have collaborated with federal and private sector partners on interoperability-related surveys to answer a big picture question: “how are we doing?”
A Closer Look at the HTI-4 Final Rule
By Mary Griskewicz – At its core, HTI-4 is about making prescribing and medication access more real-time, transparent, and aligned with patient needs. It updates health IT certification criteria in three key areas: electronic prescribing, real-time prescription benefit (RTPB), and electronic prior authorization (ePA).
Submit Comments on the CY 2026 CMS Proposes Policy Changes for QPP
The Centers for Medicare & Medicaid Services has issued its Calendar Year 2026 Medicare Physician Fee Schedule Proposed Rule, which includes proposed policies for the Quality Payment Program.
Prior Authorization, Post Promises: Will RFK Jr.’s Bet on Voluntary Reform Deliver?
By Brady Bizarro Esq. – In a move that’s already generating buzz across the healthcare landscape, Health and Human Services Secretary Robert F. Kennedy, Jr. recently announced that the country’s largest health insurers have agreed to voluntarily streamline the controversial prior authorization process.
CMS Star Ratings: Keeping up with the 2026 Final Rule
By Marge Ciancetta – Among the most impactful changes released by CMS each year in the Medicare Advantage and Part D Final Rule are adjustments to the Star Ratings program. As a result of the most recently finalized changes, CMS projects a 0.69% decline in overall quality bonus payments for 2026.
The $50 Billion Rural Health Fund in the New Reconciliation Law
By Chris Emper – Although not focused on healthcare, the bill does include 115-pages of healthcare provisions, most of which are focused on reducing future Medicaid spending as a mechanism to reduce the overall budgetary impact of the bill.
TEFCA’s growing, are you in? Take a look at who’s participating in TEFCA Exchange
By Steven Posnack & Jawanna Henry – We are pleased to announce that the beta version of an interactive, searchable map for TEFCATM participation is now available. The map released recently is another example of our commitment to transparency.
5 Downstream Effects of The Big Beautiful Bill on Hospitals and Patients
By Trish Rivard – On July 4, 2025, President Trump signed the ‘Big Beautiful Bill Act’ into law. Under the law’s new Medicaid and Affordable Care Act marketplace policies, federal funding will decrease by $1 trillion while the uninsured population will increase by 11.8 million over the next decade.