Wednesday, May 27, 2026

A new Iowa law, effective July 1, 2026, requires all state-regulated health plans to cover biomarker testing for cancer diagnosis and treatment. The law specifically prohibits prior authorization for biomarker tests when the ordering provider is in-network and the lab is in-network. For out-of-network labs, prior authorization is still permissible. This operational change requires oncology practices to verify patient plan type and network status before ordering these tests to avoid delays and denials. Update your internal lab-ordering protocols for Iowa patients to comply by the July 1 effective date.

CMS has issued clarifying guidance on its nationwide six-month moratorium on new Medicare enrollments for hospices and home health agencies, effective May 15, 2026. The agency debunks several myths, confirming the freeze applies to new provider applications and changes in ownership for existing providers seeking to re-enroll. It does not affect revalidations or re-enrollments for existing, unchanged providers. For practices that refer to or partner with these entities, monitor the CMS-855A application portal for status updates and expect processing delays for any new partnerships until the moratorium lifts in November 2026.

CVS Health is suing the state of Tennessee over its new pharmacy benefit manager law, which the company argues effectively creates a state-sponsored PBM monopoly. The lawsuit claims the law violates the federal Employee Retirement Income Security Act (ERISA) and the Commerce Clause. The outcome of this legal challenge will set a precedent for similar state-level PBM regulations, which directly impact pharmacy network contracts and prescription drug reimbursement for commercially insured patients. Watch for similar legal challenges in other states with restrictive PBM legislation.

EHR and RCM vendor CareCloud has completed its acquisition of Empower Healthcare & Compliance Partners, a firm specializing in AI-powered compliance and audit support. The deal extends CareCloud’s service footprint to an estimated 45,000 providers. This vertical integration signals a continued industry trend of RCM platforms bundling automated compliance monitoring and audit defense tools directly into their offerings. For practices using CareCloud or similar platforms, expect increased sales outreach for add-on compliance modules in the coming quarters.

A consortium of rural hospitals argues that $50 billion in recently announced federal grant funding will not offset the financial impact of looming Medicaid reimbursement cuts. The report highlights that the grants are one-time infusions, while the proposed cuts to state-directed payments represent a permanent reduction in baseline revenue. This financial pressure increases the risk of further service reductions or closures at rural facilities, which would shift patient volume and complex billing cases to remaining regional providers. The sustainability of rural healthcare infrastructure remains a critical policy issue with direct downstream effects on referral networks and patient access.