Government
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CMS ousts 2 No Surprises arbiters as critics question impartiality
Earlier this week, the Trump administration denied recertification requests from Island Peer Review Organization and Network Medical Review Company. Insurers cheered the decision, though both arbiters said they could appeal.
By Rebecca Pifer Parduhn • Nov. 6, 2026 -
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New CMS rule ties Medicare billing privileges to owner conduct
Regulators have expanded powers to revoke providers’ Medicare certification, including for parent companies that violate federal rules.
By Jacqueline LaPointe • Nov. 6, 2026 -
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TrendlineSurprise Billing
Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.
By Healthcare Dive staff -
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Medicare finalizes physician pay cut for 2027
Regulators trimmed doctors’ Medicare payments and hammered out other policies to reduce duplicative reimbursement. Providers slammed the cuts, saying they would further destabilize the sector.
By Sydney Halleman • Nov. 5, 2026 -
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Medicare will cut billions from 340B, expand site-neutral payments in 2027
Regulators finalized a rule Wednesday that would slash payments for drugs in the controversial 340B program and equalize some payments between care sites. Hospitals railed against the rule.
By Sydney Halleman • Nov. 5, 2026 -
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How should the FDA regulate generative AI in medtech? Here are 5 takes
Patients, providers and medtech firms submitted hundreds of comments to the Food and Drug Administration on how the agency should approach generative AI in medical devices.
By Elise Reuter • Nov. 3, 2026 -
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Medicare Part D premiums are spiking 50% on average next year, KFF finds
The health policy think tank urged seniors to shop carefully for prescription drug coverage during Medicare open enrollment, given skyrocketing premiums and wide variance in costs between plans.
By Rebecca Pifer Parduhn • Nov. 2, 2026 -
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Judge strikes down CMS ‘medical frailty’ policy for Medicaid work requirements
It’s a victory for more than two dozen states that had sued to block the definition, along with providers, consumer advocates and other critics that had opposed it. The CMS could still appeal the decision.
By Rebecca Pifer Parduhn • Oct. 30, 2026 -
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Labor Department finalizes sweeping PBM disclosure rule
Starting in 2027, the controversial drug middlemen will have to share a broad swath of fee and compensation data with self-funded employer clients. Employers cheered the rule, while PBMs slammed it as government overreach.
By Rebecca Pifer Parduhn • Oct. 29, 2026 -
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CVS sues to prevent $2B Medicare Advantage star ratings hit
It’s at least the fifth insurer to turn to the courts in a bid to hike its ratings for next year. The lawsuits make near-identical legal arguments. But CVS’ is more dramatic in its scope and alleged financial harm.
By Rebecca Pifer Parduhn • Oct. 28, 2026 -
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ONC cuts health IT certification criteria in HTI-5 final rule
The regulation cuts 14 criteria and revises seven to make ONC's health IT certification easier to achieve, but delays decisions on information blocking.
By Anuja Vaidya • Oct. 27, 2026 -
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CMS proposes heightened standards for ACA financial assistance
Enrollees must jump through more hoops to verify their income and residency status before receiving subsidies for Affordable Care Act plans. Over 300,000 enrollees are expected to leave each year as a result.
By Sydney Halleman • Oct. 26, 2026 -
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Uninsured rate rises to 11% ahead of Medicaid work requirements
Cuts to federal programs and the loss of enhanced subsidies on the exchanges could deepen an existing healthcare affordability crisis, according to a new report from the Commonwealth Fund.
By Sara Heath • Oct. 26, 2026 -
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Centene sues the CMS over 2027 Medicare Advantage star ratings
The St. Louis-based insurer is adding onto a growing pile of lawsuits from insurers trying to get their quality scores recalculated — and nab hundreds of millions of dollars in extra payments as a result.
By Rebecca Pifer Parduhn • Oct. 26, 2026 -
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5 major companies pledge faster, electronic prior authorizations
Amazon, Google, Meta and other employers agreed to reform their prior authorization policies for their self-funded health plans, which provide coverage for millions of Americans.
By Jacqueline LaPointe • Oct. 23, 2026 -
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Trump administration sued for second time over ACA broker freeze
Another trade association is taking the HHS and CMS to court over their decision to lock out new agents and brokers from participating in open enrollment for 2027 Affordable Care Act plans.
By Rebecca Pifer Parduhn • Oct. 23, 2026 -
Courtesy of Grail
5 doctors weigh in on the promise, limitations of a closely watched multicancer blood test
As a screening test from Grail moves closer to Food and Drug Administration approval, cancer experts share what encourages and concerns them most about Galleri.
By Susan Kelly • Oct. 19, 2026 -
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CMS proposes rule to clean up MA provider directories, shine light on PBMs
The proposed changes would implement key healthcare provisions in a government funding package from February. The brunt of the reforms would go into effect in 2028.
By Rebecca Pifer Parduhn • Oct. 19, 2026 -
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Trade association sues Trump administration over ACA broker, agent freeze
The National Association of Benefits and Insurance Professionals alleges that the HHS violated the law by not giving the public a chance to comment on the controversial policy.
By Rebecca Pifer Parduhn • Oct. 16, 2026 -
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FDA ‘reset’ continues with new plan for reviewing rare disease drugs
A revamped regulatory framework may give investors less of a “guessing game” as they weigh chances for drug approvals, one analyst said.
By Kristin Jensen • Oct. 15, 2026 -
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CVS to pay $315M to settle opioid prescribing allegations
Prosecutors say the company filled unnecessary prescriptions that fueled the opioid epidemic. A spokesperson for CVS said the company admitted to no wrongdoing and strongly disagreed with the case’s claims.
By Sydney Halleman • Oct. 14, 2026 -
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Alignment sues CMS over 2027 Medicare Advantage star ratings crash
The lawsuit isn’t a surprise, after Alignment told investors it would take all available actions to improve its quality scores.
By Rebecca Pifer Parduhn • Oct. 13, 2026 -
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New bill would overhaul the No Surprises Act’s arbitration process
Legislation introduced last week by Rep. Frank Pallone, D-N.J., would get rid of the arbitration process set up by the No Surprises Act entirely, the latest sign of growing interest on the Hill to reform the consumer protection law.
By Sydney Halleman • Oct. 12, 2026 -
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Humana soars, Alignment plummets in 2027 Medicare Advantage star ratings
A Healthcare Dive analysis of highly anticipated stars data shows a mixed bag of winners and losers, though — as expected — the quality scores slipped overall. See how major carriers fared for 2027.
By Rebecca Pifer Parduhn • Oct. 9, 2026 -
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HHS launches new plan to strengthen vaccine injury research, reporting
Spearheaded by vaccine skeptic Robert F. Kennedy Jr., the initiative will involve a new NIH clinic, an updated monitoring system and reimbursements for doctors who report suspected side effects.
By Delilah Alvarado • Oct. 8, 2026 -
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Texas attorney general investigates UnitedHealth over care denials
Ken Paxton is on the hunt for evidence that UnitedHealth is breaking the Deceptive Trade Practices Act and other Texas laws, citing “alarming reports” of denied care.
By Rebecca Pifer Parduhn • Oct. 7, 2026
