Billy Wynne

Agency Announces ASC Prior Authorization Demonstration The Centers for Medicare and Medicaid Services (CMS) announced a prior authorization demonstration program for certain ambulatory surgical center (ASC) services. CMS says that prior authorization ensures that services comply with applicable Medicare coverage, coding, and payment rules before services are rendered or claims are submitted. CMS believes that this demonstration will…

HHS Announces Crackdown on Information Blocking The Department of Health and Human Services (HHS), through the Office of the Inspector General (OIG) and Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), announced that it will increase resources to address the practice of information blocking. HHS will be taking active enforcement against…

Innovation Center Extends AHEAD Model Through 2035 with a Range of Policy and Operational Changes Today, the Center for Medicare and Medicaid Innovation (CMMI) announced a set of policy and operational changes to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model and extended all cohorts through 2035 (announcement; updated FAQs, model website). The model’s acronym, created by…

Agency Releases Latest Medicaid and CHIP Enrollment Data The Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicaid and the Children’s Health Insurance Program (CHIP) from May 2025. The points below reflect the key findings. Medicaid and CHIP – As of May 2025, 78.1 million people are enrolled in Medicaid and CHIP. 70.8 million…

MSSP ACOs PY 2024 Financial and Quality Results The Centers for Medicare and Medicaid Services (CMS) recently released the performance year (PY) 2024 financial and quality results of Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). ACO-specific metrics are available here. In the fact sheet, CMS reiterates the Trump Administration’s commitment to ensuring participation in…

Agency Announces New Surveillance Tool For Organ Transplantation Out of Sequence The Health Resources and Services Administration (HRSA) launched a new public dashboard to track when organ transplants occur outside of the standard list of matched patients. The organ transplant system matches donor organs with patients based on urgency, distance, and other rules to ensure fairness. Allocation out of sequence…

Secretaries Request Detailed Plans to Include Nutrition in All Levels of Medical Education Secretary of the Department of Health and Human Services (HHS), Robert F. Kennedy Jr., and Secretary of the Department of Education, Linda McMahon, announced an initiative to encourage medical education organizations to implement comprehensive nutrition education and training. The initiative is part of the…

Institutes Releases New Implementation Guide in Support of Restoring Gold Standard Science Executive Order The National Institutes of Health (NIH) has released a new implementation plan titled “Leading in Gold Standard Science.” This announcement comes out against the backdrop of the recent Supreme Court decision to allow the Trump Administration to continue to withhold NIH…

Agency Revokes California’s Funding for Sex Education Program Citing Refusal to Remove “Gender Ideology” from Curriculum On August 21, the U.S. Department of Health and Human Services (HHS), through the Administration for Children and Families (ACF), terminated California’s federal grant for sex education after the state refused to strip references to “gender ideology” from its curriculum (press release). This…

Federal District Judge Blocks Six Major Provisions of Marketplace Rule Ahead of August 25 Implementation On August 22, U.S. District Judge Brendan Hurson granted a preliminary injunction in City of Columbus et al v. Robert F. Kennedy, Jr. et al (D. Md.), temporarily blocking the implementation of six of the eight challenged provisions of the 2025…