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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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...
HRSA announces a pilot implementing rebates instead of upfront discounts to achieve 340B ceiling prices, building on stakeholder input from prior RFI. The Health Resources and Services Administration (HRSA) has announced the availability of a revised 340B Rebate Model Pilot Program, implementing...
Rule updates hospice wage index, payment rates, and quality measures while finalizing hospice election statement addendum requirement for all Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) has issued a final rule updating the hospice wage index, payment rates, and...
Updates Medicare payment rates for inpatient rehabilitation facilities, phases out the rural adjustment, and revises quality reporting and admission timing requirements for FY 2027. This final rule from the Centers for Medicare & Medicaid Services (CMS) updates the prospective payment rates for...
The new HL7 FHIR Implementation Guide enables scalable, interoperable consent management across healthcare data exchange networks. The HL7 FHIR at Scale Taskforce (FAST) has released the Scalable Consent Management Implementation Guide to address growing challenges in consent enforcement across...
The rule sets payment rates for skilled nursing facilities in FY 2027 while refining quality measure requirements under both the SNF QRP and VBP programs. CMS has issued a final rule updating the Skilled Nursing Facility Prospective Payment System (PPS) and consolidated billing policies for...
Annual updates add and remove specific HCPCS codes from lists requiring physician face-to-face encounters, written orders, and prior authorization for Medicare coverage. The Centers for Medicare & Medicaid Services (CMS) has issued updates to three key Medicare requirement lists affecting durable...
CMS's proposed Medicare reimbursement changes for 340B drugs would reduce safety-net hospital revenues while increasing for-profit hospital revenues, according to KFF analysis. CMS has proposed cutting Medicare reimbursement for drugs purchased through the 340B Drug Pricing Program while...
CMS introduces a voluntary interoperability framework encouraging gradual adoption while establishing baseline technical requirements for network participation, raising concerns about equitable access for resource-constrained providers. The Centers for Medicare & Medicaid Services (CMS) has...
CMS and state entities will use Office of Personnel Management data to verify ACA exchange eligibility and affordability program qualifications. The Centers for Medicare & Medicaid Services (CMS) has announced the re-establishment of a matching program with the Office of Personnel Management...
The proposal merges two public health forms into a single Onsite Health Intervention Form and adds limited sharing of health data with DHS to ensure continuity of care for unaccompanied refugee minors. The Administration for Children and Families (ACF), through its Office of Refugee Resettlement...
The renewal allows NCQA to continue certifying Medicare Advantage plans through accreditation, avoiding duplicative CMS reviews. The Centers for Medicare & Medicaid Services (CMS) has approved the renewal of the National Committee for Quality Assurance's (NCQA) deeming authority for Medicare...
A working viewer for International Patient Summary documents highlights both the maturity of the IPS spec and the remaining UX friction teams face when rendering FHIR-native clinical summaries. The International Patient Summary (IPS) Implementation Guide defines a standardized, minimal set of key...
Proposed rule would revise indirect hold harmless thresholds for state health care-related taxes under the One Big Beautiful Bill Act, with changes effective October 2026 and further phase-downs in 2027. The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to implement...
Industry veteran Paul Wilder argues that the interoperability ecosystem is showing early signs of eroding participant trust — and that the next phase of data exchange will depend on fixing that foundation. Writing in MedCity News, Paul L.
HL7's fourth normative ballot of FHIR R6 is the consensus gate that will define the stable, binding specification healthcare-IT teams must eventually certify against. HL7 International has opened an out-of-cycle Normative ballot for FHIR Release 6 (v6.0.0-ballot4), with voting and comments...
CMS Request for Information on Clinical Laboratory Improvement Amendments (CLIA) aims to gather feedback on updating regulations to reflect advances in lab technology, cybersecurity, and emergency preparedness. The Centers for Medicare & Medicaid Services (CMS) has issued a Request for...
The sweeping annual PFS proposed rule touches Medicare payment rates, the Promoting Interoperability Program, Quality Payment Program, Medicare Shared Savings Program, and new IRA drug-rebate codifications — with a September 14 comment deadline. CMS published its CY 2027 Physician Fee Schedule...
Brendan Keeler contends the EHR Association isn't just venting about HTI-5 — it's methodically constructing an administrative record to challenge ONC's rulemaking authority in court. Interoperability analyst Brendan Keeler argues that the EHR Association's (EHRA) sustained public commentary...
Common Agreement Version 2 marks TEFCA's most significant structural upgrade yet, embedding FHIR API exchange, a permanent QHIN-led Governing Council, and new trust and accountability rules directly into the national interoperability framework. The Recognized Coordinating Entity (RCE) for TEFCA...
CMS fulfills its statutory obligation to review and publish the Consensus-Based Entity's annual activities report, a key checkpoint in the federal quality measurement governance cycle. The HHS Secretary has reviewed and published in the Federal Register Battelle Memorial Institute's 2025 Annual...
Elevance's lawsuit argues CMS is applying Star Ratings recalculation methodology inconsistently — a win for Clover Health in court has opened the door for other MA plans to demand the same treatment. Elevance Health filed suit last week against HHS and CMS, alleging that the agency unlawfully...
A rare moment of regulatory visibility gives health-IT teams a structured view of what's coming — and what's being undone — across interoperability and HIPAA access. Brendan Keeler's July 2026 analysis unpacks a newly visible HHS/ONC regulatory pipeline, identifying four distinct actions that...
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