Tuesday, March 24, 2026

CMS's updated price transparency rule takes effect April 1. New requirements: hospital CEOs must personally attest to the accuracy of published pricing data. Hospitals must report percentile-based allowed amounts (10th, 50th, 90th) when using algorithm-based pricing. No penalty reduction for hospitals that fail to post machine-readable files or shoppable services. Penalties tightened — the grace period is over.

New York AG settled with EmblemHealth over ghost networks — provider directories listing practitioners who aren't accepting patients, don't exist at that location, or are duplicated to inflate network size. One psychiatrist was listed 29 times. Behavioral health providers were overstated by up to 80%. Patients searching for in-network mental health care were routed to dead ends. $2.5M settlement, plus mandated directory accuracy improvements.

MA plans must publish aggregate PA approval/denial metrics by March 31. CMS killed service-level reporting — plans disclose contract-level aggregates only, not which specific procedures get denied most. Eight metrics required. First reporting cycle. No new development since yesterday — pure countdown urgency.

Enhanced ACA subsidies expired. Jessica Chamberlain's premium nearly doubled — $59.67/month to ~$100/month. Across the board: 80% of continuing enrollees report higher costs. 73% are worried about affording emergency or hospitalization costs. 17% aren't confident they can afford premiums at all. 9% of previous enrollees dropped coverage entirely.

Ocean McIntyre, 34, developed vision problems. Insurance took one month to authorize a doctor visit. Then three more months to authorize the specialist. By the time she saw a specialist, pressure in her brain had crushed her optic nerve. The specialist told her: "If we'd seen you earlier, we could have preserved your vision." She is now partially blind. The delay was prior authorization for routine eye care.