Tag: CMS
In brief: CMS puts Elevance Health on notice, Trace names Mark Farmer president, Next Day Access marks triple-digit growth
March 3, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) will suspend Elevance Health’s ability to enroll people in its Medicare Advantage plans if the insurer doesn’t comply with risk adjustment data submission requirements.
In a Feb. 27 letter to Elevance, CMS said sanctions would begin March 31 for Elevance’s “pattern of knowing noncompliance.”
In its letter, CMS states: Since...
CMS says 22.8M consumers have signed up for insurance through Marketplaces
January 15, 2026HME News Staff
WASHINGTON - The Centers for Medicare & Medicaid Services (CMS) reports that 22.8 million consumers have signed up for individual market health insurance coverage through the Marketplaces since the start of the 2026 Marketplace Open Enrollment Period (OEP) on Nov. 1, 2025. This includes 15.6 million Marketplace plan selections in the 30 states using the HealthCare.gov platform for the 2026 plan year and 7.2 million plan selections in the 20 states and the District of Columbia...
CMS to scrutinize immigration status for Medicaid, CHIP
August 21, 2025HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has launched an oversight initiative to ensure that enrollees in Medicaid and the Children’s Health Insurance Program (CHIP) are U.S. citizens, U.S. nationals, or have a satisfactory immigration status.
CMS will begin providing states with monthly enrollment reports identifying individuals whose citizenship or immigration status could not be confirmed through federal databases, including the Department of Homeland...
White House, tech leaders commit to rebuilding health care system
July 31, 2025HME News Staff
WASHINGTON – The White House and CMS have secured commitments from major health care and information technology firms – including Amazon, Anthropic, Apple, Google and OpenAI – to begin laying the foundation for a next-generation digital health ecosystem that they say will improve patient outcomes, reduce provider burden and drive value.
“For decades, bureaucrats and entrenched interests buried health data and blocked patients from taking control of their health,”...
CMS signals potential big changes to bid program
July 3, 2025Theresa Flaherty, Managing Editor
WASHINGTON – Industry stakeholders await more details, but their initial analysis of CMS’s proposed rule for a new round of competitive bidding has them worried the agency plans to significantly expand the program to new product categories and impose new requirements.
Are CGMs a hot-ticket item?
In the June 30 announcement, CMS said product categories and a specific timeframe for the next round will be announced at a future date. Yet the agency highlighted continuous...
Dr. Oz launches Medicare enrollment series
June 11, 2025HME News Staff
WASHINGTON – CMS Administrator Dr. Mehmet Oz, who turns 65 today, is using his own Medicare enrollment experience to help Americans better understand how to sign up for Medicare and select the coverage that best fits their needs. Through a new video and social media series, Dr. Oz is walking future enrollees through simple steps they can take to get started—beginning with Medicare.gov. “Millions of Americans become eligible for Medicare each year, and this year, I’m one of...
CMS releases final NCD for non-invasive ventilation
June 9, 2025HME News Staff
WASHINGTON – CMS has released a final national coverage determination (NCD) for non-invasive positive pressure ventilation (NIPPV) in the home for the treatment of chronic respiratory failure consequent to COPD.
The final NCD:
Provides coverage of respiratory assist devices (RADs) for the treatment of chronic respiratory failure that often accompanies COPD; and
For the first time, establishes coverage for home mechanical ventilation for patients with COPD.
For...
CMS awards RAC contracts to Cotiviti
June 4, 2025HME News Staff
WASHINGTON – CMS in April named Cotiviti GOV Services the new Recovery Audit Contractor (RAC) for Region 3, 4 and 5. These three contracts, awarded through a competitive procurement process, will support post-pay review of Medicare claims in these regions to efficiently identify and correct overpayments and underpayments made to health care providers with a focus on the quality, accuracy and transparency of reviews, the recovery of improper payments and the reduction of provider burden, Cotiviti...
CMS: Gov't must be ‘catalyst’ to digital health
May 14, 2025HME News Staff
WASHINGTON – CMS, in partnership with the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), seeks public input on how best to advance a seamless, secure and patient-centered digital health infrastructure.
The goal is to unlock the power of modern technology to help seniors and their families take control of their health and well-being, manage chronic conditions and access care more efficiently, the agency says.
“We...
Proposed rule would establish more guardrails for Medicare Advantage
December 4, 2024HME News Staff
WASHINGTON – CMS is proposing changes to the Medicare Advantage (MA) and Medicare Part D prescription drug programs to hold them more accountable for delivering high-quality care for people with Medicare.
In the Contract Year 2026 MA and Part D proposed rule, CMS proposes addressing inappropriate use of prior authorization and internal coverage criteria, including by defining the meaning of “internal coverage criteria” to clarify when MA plans can apply utilization management,...