Congressional Opposition to WISeR Model Demands Performance Data From CMS
A congressional coalition sent a letter on June 22 to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D., expressing...
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The Centers for Medicare & Medicaid Services opened a Request for Information (RFI) asking for public comment about how to modernize Medicare Advantage (MA).
The RFI follows a proposed rule, issued on Nov. 25, 2025, that would revise the MA program and the Medicare Cost Plan Program, along with the Medicare Prescription Drug Benefit Program (Part D), for contract year 2027. The rule would remove 12 unique measures to create a Star Ratings system, intended to be more focused and better at measuring and incentivizing quality improvements. Additionally, the rule would offer a new special enrollment period (SEP) for provider terminations and codify related policy regarding SEP utilization.
CMS invites public feedback on MA modernization, including ways to improve competition, refine risk adjustment, and align quality incentives. The RFI seeks public input on whether CMS could meet its objectives through either a time-limited test model under the CMS Innovation Center’s authority or potential program-wide regulatory changes.
The proposed rule will be open for public comment for 60 days, until Jan. 24, 2026.
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Final Month of PAMA Reporting: Is Your Lab Ready?
July marks the final month of the 2026 PAMA reporting period. Laboratories that meet the definition of an applicable laboratory, which most do, have...
Humana Claims Payment Policies
Effective July 1, 2026, Humana will charge a $5.00 administrative fee for Medicare Advantage paper claim submissions.