Track the CMS Interoperability and Prior Authorization API final rule (CMS-0057-F) — the Patient Access, Provider Access, Payer-to-Payer and Prior Authorization APIs payers must stand up — with every deadline linked to its primary source.
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The rule mandates standardized APIs, reduces prior authorization burdens, and aligns with FHIR to improve data exchange and patient access. The Centers for Medicare & Medicaid Services (CMS) issued a final rule that combines interoperability initiatives with prior authorization reforms to...
Teal Health raises funding to prepare for increased demand as CMS requires health plans to cover self-collected tests at no cost starting in 2027. Teal Health has raised $22 million in funding to prepare for an expected surge in demand stemming from a new federal coverage mandate.
The finalized model applies international price comparisons to Medicare Part B drugs, potentially reshaping reimbursement for oncology and specialty therapies. The Centers for Medicare & Medicaid Services (CMS) has finalized the Most Favored Nation (MFN) Model, which aims to align Medicare Part B...
A new CMS-led initiative seeks to overhaul how quality is measured across Medicaid and CHIP programs in partnership with a majority of states. The Trump administration announced a new partnership between CMS and 37 states aimed at fundamentally rethinking quality measurement approaches for...
The partnership will test whether combining AI-driven primary care with Oura Ring data can improve outcomes for patients with cardio-kidney-metabolic conditions under a value-based payment model. Counsel Health, an AI-native primary care company, will participate in the CMS Innovation Center's...
Federal audit reveals Part D plans improperly reimbursed for over-the-counter medications not covered under Medicare prescription drug benefit. The Office of Inspector General (OIG) within HHS released an audit finding that Medicare Part D plans made millions of dollars in payments for...
Settlement resolves allegations that Florida-based primary care network inflated Medicare Advantage risk scores through improper diagnosis submission. The Villages Health System has agreed to pay $541.5 million to settle allegations that it submitted false diagnosis codes to the government to...
The AMA supports CMS's revised guidance addressing payer compliance with prior authorization transparency requirements under the 2024 Interoperability and Prior Authorization final rule. The American Medical Association (AMA) has publicly endorsed updated guidance from the Centers for Medicare &...
The ONC's refreshed TEFCA fact sheet shows Qualified Health Information Networks now connect over 150 million unique patients and 1.8 million clinicians, underscoring rapid national scaled exchange under the Trusted Exchange Framework. The Office of the National Coordinator for Health IT (ONC)...
A study found four mandatory CMS VBC programs generated substantially higher administrative expenses compared to non-participating hospitals. Researchers analyzing Medicare cost reports determined that four mandatory value-based payment programs administered by CMS were associated with more than...
The investigation examines whether Epic's health IT dominance and data-sharing policies violate antitrust laws, with potential implications for interoperability and EHR market competition. The U.S.
HRSA is proceeding with the 340B Rebate Model Pilot Program starting January 1, targeting 25 potentially eligible drugs despite covered entities' concerns about administrative burden. The Health Resources & Services Administration (HRSA) is advancing its revised 340B Rebate Model Pilot Program,...
CMS locks in inpatient hospital payment update at 2.3%, below earlier proposal but projecting hundreds of millions in higher hospital payments from rule changes. The Centers for Medicare & Medicaid Services (CMS) has finalized the Inpatient Prospective Payment System (IPPS) rule, establishing a...
Despite reports of delays, HHS confirms it is proceeding with a final rule that would bar providers offering pediatric gender-affirming care from receiving Medicare and Medicaid reimbursement. HHS rebuked a recent report claiming that a controversial proposal to add pediatric gender-affirming...
The health plans allege CMS' methodology unfairly penalizes MA plans, potentially affecting reimbursement and plan competitiveness in the 2026 star ratings cycle. SCAN Health Plan and Alignment Healthcare have filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) alongside...
By embedding structured clinical terminology directly into CPT codes, AMA aims to accelerate electronic prior authorization and cut administrative burden at the point of care. The American Medical Association has launched a new interoperability initiative focused on mapping structured clinical...
The Trusted Exchange Framework and Common Agreement has crossed a major adoption threshold, signaling that the national interoperability network is moving from pilot to production scale. The Office of the National Coordinator for Health Information Technology (ONC) has announced that TEFCA — the...
The Senate's vote to preserve WISeR clears a key political hurdle for CMS's first AI-driven prior authorization model in fee-for-service Medicare. Democratic lawmakers in both the Senate and House introduced Congressional Review Act-style resolutions in May seeking to overturn the CMS WISeR...
HHS/ONC's fifth Health Data, Technology, and Interoperability rulemaking targets certification program efficiency and continued information-blocking enforcement improvements. HHS and ONC have proposed the HTI-5 rule, the latest in the Health Data, Technology, and Interoperability rulemaking...
CMS's official FAQ spells out exactly what payers must do under CMS-0057-F — from 72-hour urgent decision windows to the nine public metrics due on websites by March 31, 2026. CMS has published a detailed FAQ on the Prior Authorization API requirements established in the 2024 CMS Interoperability...
New federal oversight measures — including third-party audits of TEFCA participants — signal ONC is shifting from network-building to network-accountability mode. ONC has announced a package of oversight measures designed to strengthen governance of the Trusted Exchange Framework and Common...
With HTI-4 finalized on August 4, 2025, ONC has now closed out four major rulemakings that together reshape certification criteria, information blocking, TEFCA, and prescription workflows. ONC's certification program regulations page now reflects a completed four-rule cycle stretching from early...
Medicare Advantage, Medicaid, CHIP, and Marketplace payers must deploy four new FHIR APIs and compress prior authorization timelines by 2026–2027, reshaping payer-provider-patient data exchange across the industry. CMS has finalized the Interoperability and Prior Authorization rule (CMS-0057-F),...
ONC's certification framework — the gatekeeper for federally recognized health IT — is updating criteria, surveillance rules, and standards versioning processes that every EHR and API developer must track. The ONC Health IT Certification Program is the federal mechanism through which health...
As CMS's LEAD model extends value-based care timelines, health systems that lack real-time post-acute data will find themselves structurally disadvantaged on cost and quality performance. CMS's LEAD (Longitudinal Episode-based Alternative Payment) model reshapes how accountable care organizations...
The 2024 CMS Interoperability and Prior Authorization final rule sets hard compliance deadlines for payers to implement FHIR APIs that streamline prior authorization and cross-payer data exchange — with a key HIPAA carve-out clearing the path. CMS released the 2024 Interoperability and Prior...
New conflict-of-interest protections and updated performance-review requirements will reshape how the nine CMS-recognized accrediting organizations survey more than 9,000 Medicare-participating providers. CMS has issued a final rule updating the regulatory framework governing the organizations...
The scale of non-compliance enforcement is larger than previously disclosed, signaling CMS is actively using its price transparency authority against a broad swath of providers. At least 519 hospitals across the country have received either a warning notice or a Corrective Action Plan (CAP)...
The agency is formalizing its ambitions in health-IT modernization by creating a dedicated organizational unit to lead interoperability initiatives and digital product development. The Centers for Medicare & Medicaid Services (CMS) has established a new health technology office designed to...
New payment model tests alternative inflation rebate calculations for Part B drugs to reduce costs while preserving quality in Original Medicare. The Centers for Medicare & Medicaid Services (CMS) has issued a final rule implementing the Global Benchmark for Efficient Drug Pricing (GLOBE) Model,...
A CMS correction addresses technical errors in the final rule governing IRF Medicare payments and quality reporting for federal fiscal year 2027, ensuring accurate implementation. On October 1, 2026, the Centers for Medicare & Medicaid Services (CMS) published a correction to the final rule...
A correction addresses technical errors in the FY 2027 Inpatient Psychiatric Facilities Prospective Payment System rate update, impacting reimbursement calculations for psychiatric hospitals. The Centers for Medicare & Medicaid Services (CMS) issued a correction to technical errors in the final...
Technical correction addresses errors in the Medicare hospice payment and quality reporting requirements for fiscal year 2027. The Centers for Medicare & Medicaid Services (CMS) published a technical correction to the Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and...
Correction addresses typographical and technical errors in the August 2026 final rule that established FY 2027 payment rates and adopted updated versions of certain health information technology standards for hospitals. The Centers for Medicare & Medicaid Services (CMS) published a correction to...
HHS and CMS pause new agent/broker enrollment through Federally-facilitated Exchanges for Plan Year 2027 to implement program-integrity safeguards against fraud and misuse of consumer data. The Department of Health and Human Services (HHS) issued an interim final rule with comment period that...
The September 30 HL7 Da Vinci Community Roundtable will provide updates on ePA regulatory developments, implementation guide status, and real-world deployment progress as the industry moves beyond pilots to production. HL7 International announced that the Da Vinci Project will hold a Community...
DirectTrust's modernized Direct implementation enables cloud-native secure messaging while maintaining compatibility with legacy healthcare workflows. DirectTrust has unveiled a modernized implementation of the Direct Project protocol designed specifically for cloud environments and...
Leveraging P2P data exchange for strategic initiatives like network development and care management transforms compliance into market differentiation. Payer-to-payer (P2P) interoperability capabilities, once viewed primarily as a regulatory requirement under TEFCA’s QHFN, are evolving into...
A single award recipient will receive supplemental funding to support rural health care quality improvement through measure implementation, data reporting, and improvement initiatives. The Health Resources and Services Administration (HRSA), part of the U.S.
CDC invites comments through Nov. 20, 2026 on how data intermediaries can support secure, standards-based public health data sharing to improve disease detection and prevention. The Centers for Disease Control and Prevention (CDC) is soliciting public input on the role of data intermediaries in...
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