Saturday, June 13, 2026

The Texas Organization of Rural & Community Hospitals announced it will terminate its contracts with UnitedHealthcare. The decision, affecting multiple member hospitals, cites unsustainable reimbursement rates that fail to cover the cost of care. Practices with patients covered by UHC through these rural hospitals must prepare for potential out-of-network status and communicate with patients about coverage changes. Verify patient eligibility and plan details for any scheduled care, and be ready to implement out-of-network billing procedures if new contracts are not reached.

In Black Book's annual survey of payer prior authorization technology, eviCore, Cigna's utilization management subsidiary, ranked highest in user satisfaction among health plans. The survey measures ease of use, integration, and administrative burden from the provider perspective. This ranking reflects ongoing industry consolidation around a few large prior authorization platforms, which can standardize workflows but also centralize denial power. For practices dealing with Cigna, this signals that eviCore's portal and processes are likely to remain the primary interface for authorization requests in the near term.

A Department of Health and Human Services Office of Inspector General report indicates the three largest Medicare Advantage insurers denied prior authorization requests for post-acute care at unusually high rates, suggesting potential profit-driven denials. The report focused on skilled nursing and inpatient rehabilitation admissions, finding patterns that raise concerns about patient access and plan compliance. Practices with high volumes of post-acute referrals to UHC, Humana, or Aetna MA plans should monitor appeal rates and administrative burden closely. The findings could fuel legislative pressure for stricter oversight of MA prior authorization practices.

The Centers for Medicare & Medicaid Services created an office dedicated to increasing oversight of state Medicaid demonstrations and section 1115 waivers. This move signals a federal shift toward stricter monitoring of how states implement and finance Medicaid expansions, work requirements, and other waiver-driven programs. For practices operating in states with active or pending waivers, such as those with work requirements or directed payment arrangements, the change means federal approval and compliance reviews may become more rigorous and less predictable. This could affect the stability of Medicaid reimbursement streams tied to waiver programs.