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MA plans, state Medicaid/CHIP programs, and QHP issuers must publish aggregate prior authorization metrics for calendar year 2025 on their websites by Tuesday. Approval rates, denial rates, appeal outcomes, average decision turnaround times — all public for the first time. This is the first reporting cycle.
CEO attestation now required. Hospitals must post median allowed amounts, 10th/90th percentile allowed amounts, derived from ERA data. CMS offering 35% CMP reduction for hospitals that waive hearing rights — but not for hospitals that fail to post machine-readable files at all. Three years of toothless rules end Tuesday.
Class action investigation for CVS/Aetna Medicare Advantage policyholders. Allegation: CVS used AI to vet post-acute care claims (skilled nursing, rehab, home health) before any medical professional reviewed them. Senate found CVS post-acute denial rate 3x higher than overall PA rate. Second major AI-denial lawsuit in three weeks after UnitedHealth nH Predict. CVS also paid $118M over separate Medicare Advantage fraud (March 12).
Congress created a $50 billion fund to save rural hospitals. At least 10 states say the fund's structure incentivizes "right-sizing" — cutting inpatient services, closing wards, converting to rural emergency hospitals. 380 independent rural hospitals at risk of closure. Boulder City Hospital (NV) laid off ~70 workers and ended stays longer than 24 hours. Average rural hospital stands to lose $630,665 in patient revenue in 2026 from Medicaid cuts.