Senate Democrats move to roll back Medicare AI prior authorization pilot

The Latest

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  CMS finalizes major changes to ACA exchanges, including greater access to catastrophic plans

  The Trump administration continues to open the doors to the cheap, high-deductible coverage, to the worry of insurance experts and stakeholders in the healthcare industry.

  Payer

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  Sponsored by Brault

  Emergency medicine revenue at risk: Navigating the algorithmic squeeze

  Diagnosis-based downcoding is surging. Emergency physicians are paying the price.

  Finances

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  Q&A

  Aetna’s chief digital and technology officer on how the insurer is using AI for patient engagement

  Nathan Frank discusses how the insurer is using AI to engage members, how the company thinks about risks, and the importance of monitoring the tools and soliciting feedback.

  Payer

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  Surprise Billing

  Employer groups, unions urge Trump administration to reform No Surprises dispute resolution

  Providers are reaping high award amounts, and arbiters have “structural conflicts of interest” that incentivize a high volume of disputes, driving up healthcare costs for employers and patients, the groups wrote.

  Payer

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  Supreme Court preserves access to abortion pill by mail

  The ruling maintains access to mifepristone while litigation continues. The drug can still be prescribed at pharmacies or by mail without requiring in-person visits.

  Government

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  Employers say they’re doing enough to help with medical costs, but workers disagree

  The study highlights “a significant disconnect between how employers believe they are supporting employees and how employees say they feel,” Prudential Financial said.

  Payer

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  Private equity firm closes $1.1B take-private deal of home health and hospice provider Enhabit

  Executives at Enhabit said resources from private equity firm Kinderhook would help spur growth and strengthen its clinical capabilities. Enhabit’s stock ceased trading on the New York Stock Exchange on Friday.

  Updated May 18, 2026

  Medical Groups

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  CMS launches initiative to speed electronic prior authorization adoption

  The effort, part of the agency’s ambitious Health Tech Ecosystem, aims to accelerate the industry’s progress before requirements on electronic prior authorization go into effect next year.

  Hospitals

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  Physicians skeptical of insurer pledges to reform prior authorization: survey

  Only 33% of physicians surveyed by the American Medical Association said they believed voluntary pledges made by major insurers last year to reform prior authorization would result in any meaningful difference to the industry.

  Hospitals

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  Labcorp expands Epic pact to make full test menu available

  The Labcorp agreement continues the expansion of Aura, which gives healthcare providers access to tests from companies including Quest Diagnostics.

  Health IT

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  CMS suspends new Medicare enrollment of hospice, home health providers

  The agency is halting enrollments for six months as part of the Trump administration’s broader attempt to crack down on fraud. Hospice and home health groups said they largely supported the moratorium.

  Payer

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  Oracle adds Cleveland Clinic CEO to board of directors

  Dr. Tomislav Mihaljevic’s appointment comes months after Oracle named former Quest Diagnostics CEO Stephen Rusckowski to the board as the technology giant expands its reach in the healthcare sector.

  Hospitals

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  Mayo Clinic CEO to step down at year’s end

  Dr. Gianrico Farrugia has led the system since 2019. The Rochester, Minnesota-based health system said it could elect Mayo’s next leader in November.

  Hospitals

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  FDA chief Marty Makary resigns from agency, ending tumultuous tenure

  Makary’s exit ends a turbulent run marred by leadership upheaval, mass layoffs, political pressure and public spats with drugmakers.  

  Government

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  Worker strikes cost Kaiser over $1B in Q1

  Strikes at Kaiser, including a monthlong work stoppage among 31,000 nurses and other employees, added to the nonprofit health system’s rising expenses in the first quarter, which dinged its operating margin.

  Hospitals

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  Bayesian Health gets FDA nod for AI sepsis detection tool

  Created by Johns Hopkins University researchers, the early warning system for sepsis aims to help physicians detect the serious condition earlier.

  Health IT

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  Tracker

  Tracking healthcare data breaches

  A data breach at a telehealth company may have exposed data from 716,000 people.

  Updated May 13, 2026

  Hospitals

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  Employers say they prefer rebate-free PBM models

  More than 90% of employers agreed a rebate-free approach is easier to understand and would improve drug price transparency, according to the survey conducted for Evernorth, which operates a pharmacy benefit manager.

  Payer

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  Optum Rx shifts to fee-based PBM model in bid to boost transparency

  Clients of the drug middleman can pay monthly fees per member that aren’t linked to manufacturers’ list prices or prescription volume.

  Payer

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  MACPAC calls for increased transparency in Medicaid AI prior authorization

  The influential advisory group is recommending policies to boost human oversight and visibility into how Medicaid plans are using the technology, in a bid to prevent risks like inaccuracies or data bias.

  Payer

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  Feds propose rule to help employers expand fertility benefit coverage

  The proposal addresses a key plank in President Donald Trump’s labor agenda and would exempt fertility benefits from the requirements of some federal health coverage laws.

  Payer

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  Sanford targets Minnesota growth again with planned deal

  Sanford has signed an agreement to add two-hospital system North Memorial Health to its portfolio. If approved, the combination would allow Sanford to expand more deeply in the state after past deals fell apart.

  Updated May 12, 2026

  Hospitals

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  Healthcare sector continues to buoy job growth

  “Remove healthcare from the equation, and the US labor market is actually losing more than it is gaining,” one economist said.

  Government

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  Cross Country Healthcare to be taken private by PE firm for $437M

  The deal comes months after an acquisition by travel nursing agency Aya Healthcare collapsed.

  Hospitals

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  Federation of American Hospitals taps new government relations head

  Elizabeth Schwartz will head up government relations at the for-profit hospital trade association as health systems brace for federal funding cuts.

  Hospitals

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  Amwell expects smaller losses in 2026 after Q1 performance

  The health technology firm’s results give Amwell “increased confidence” it will meet a long-term goal of achieving positive cash flow from operations in the fourth quarter, CFO Mark Hirschhorn said.

  Health IT

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