Tuesday, March 31, 2026

Today, every Medicare Advantage plan, state Medicaid/CHIP managed care program, and QHP issuer must publish aggregate prior authorization metrics for calendar year 2025 on their public websites. Approval rates. Denial rates. Appeal outcomes. Average turnaround times. First time this data exists outside payer walls.

Tomorrow, CEOs must personally attest to pricing data accuracy. Hospitals must post median allowed amounts and 10th/90th percentile allowed amounts from ERA data. CMS reduces CMPs by 35% for hospitals that waive hearing rights — real penalties for non-compliance start now. Three years of toothless transparency rules end with a signature line.

CMS finalized a rule to phase out fax and paper claims documentation in favor of electronic submissions. The rule establishes national HIPAA-adopted standards for claims attachments — medical records, imaging, clinical notes, lab results. Projected annual savings: $781 million. Enforcement timeline TBD but the direction is irreversible.

Aurora McCausland, 300K followers, has lipedema. Her doctor prescribed two liposuction surgeries totaling $35,000. Cigna denied coverage twice. McCausland says Cigna used her active social media presence to argue she wasn't sick enough. Her legs throb, swell unpredictably, feel "like they're filled with cement." Stage 1 patients can have crippling pain that doesn't show on camera. Story still in active news cycle — three outlets in four days.

Governor signed HB 306 — hospitals and health systems can no longer charge facility fees directly to patients for preventive outpatient care, vaccinations, and telehealth visits. The law also strengthens patient notice requirements and standardizes billing to reduce surprise charges. First state to carve out facility fee exemptions for telehealth specifically.