5 stories · 2-minute read
CMS dropped 11 Star Ratings measures focused on administrative processes and added a new Depression Screening and Follow-Up measure for the 2027 measurement year. Separately, CMS is codifying supplemental benefit debit card requirements — cards must be electronically linked to plan-covered items at the point of sale. Effective June 1, 2026.
March 31 was the first public reporting deadline under CMS's Interoperability and Prior Authorization Final Rule. Insurers must now post approval rates, denial rates, appeal overturn rates, and processing times on their public websites. The data covers calendar year 2025. Applicable to MA plans, state Medicaid/CHIP programs, managed care plans, and ACA exchange carriers. Yesterday's pulse noted KFF called the initial data "offers little insight" — but the reporting infrastructure is now live and precedent is set.
New Mountain Capital combined Access Healthcare (27,000 employees, RCM services), SmarterDx (clinical AI for revenue integrity), and Thoughtful.ai (RCM AI agents) into Smarter Technologies. The combined entity: 500,000+ providers, 400M+ transactions, $200B+ revenue managed, $800M+ in revenue. CEO is Jeremy Delinsky, former CTO of athenahealth.
Eric Tennant, 58, a coal-mining safety instructor from Bridgeport, WV, died September 17, 2025 from stage 4 bile duct cancer. His insurer, the Public Employees Insurance Agency, repeatedly denied a $50,000 histotripsy procedure — calling it "experimental and investigational." The insurer reversed only after KFF Health News and NBC News posed questions. By then, Tennant was too sick for the procedure. West Virginia's Republican governor signed a bill on April 1, 2026 (effective June 10) allowing patients approved for a course of treatment to pursue alternative medically appropriate treatments of equal or lesser value without new prior auth.
On January 22, CEOs of UnitedHealth, CVS Health, Cigna, Elevance, and Ascendiun testified before the House Energy and Commerce Committee. Rep. Nanette Barragan cited a one-time equity award of $60M to one executive. Rep. Buddy Carter questioned CVS's $41M CEO compensation package. Meanwhile, MA prior authorization denials jumped 56%. Two-thirds (66%) of insured adults told KFF in January 2026 that insurer delays and denials are a "major problem."