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 protect the Medicare Trust Fund from improper payments and ensure that… (McClurg, September 4, 2025) #Ambulatory Surgical Centers, #Demonstration Programs, #Program Integrity

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 entities that restrict patient engagement in their own care by blocking… (McClurg, September 3, 2025) #Health Information Technology

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 the Biden Administration, originally stood for States Advancing All-Payer Health Equity Approaches and Development. Key changes are described below: Model-wide… (Testa, September 2, 2025) #Delivery Reform, #Demonstration Programs, #Primary Care

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 are enrolled in Medicaid and 7.3 million are enrolled in CHIP. In total,… (Marceno, August 29, 2025) #Insurance Coverage, #Public Health

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 MSSP, noting that the program aligns with HHS Secretary Kennedy’s “Make American Healthy… (Llamas, August 29, 2025) #Accountable Care Organizations

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 (AOOS) happens when a transplant is offered, accepted, or transplanted outside of the expected order. HRSA… (McClurg, August 27, 2025) #Program Integrity, #Transparency

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 Make America Healthy Again (MAHA) focus on using nutrition to prevent and manage chronic disease. HHS emphasizes that… (McClurg, August 27, 2025) #Nutrition, #Workforce

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 grants that were deemed to promote diversity, equity, and inclusion initiatives (Impact Summary). The guide states that the NIH… (Marceno, August 26, 2025) #Clinical Labs, #Comparative Effectiveness Research, #Grants, #National Institutes of Health

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 decision is expected to cut off $12.3 million in remaining funds for the California Personal Responsibility Education Program (CA PREP), which provides… (Eisen, August 25, 2025) <span style="font-size:90%;

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 Marketplace Integrity and Affordability Rule, which were scheduled to take effect as early as August 25, 2025. Detailed summaries of each… (Eisen, August 22, 2025) #Affordable Care Act, #Costs