Thursday, June 25, 2026

CMS has issued a proposed rule aiming to cut the maximum decision time for Medicare Advantage prior authorizations from 14 days to 7 calendar days for standard requests, and from 72 hours to 24 hours for expedited requests. The rule, detailed in a notice from the Texas Medical Association, would also mandate that MA plans disclose their prior auth criteria publicly and report denial rates annually. This move addresses widespread provider complaints about delays in care and opaque decision-making. The proposed changes are subject to a public comment period before finalization. Practices should monitor CMS-2026-XXXX for the final rule and begin tracking current auth turnaround times to prepare for the potential shift.

A bipartisan group of New York lawmakers has formally called on CMS Administrator Chiquita Brooks-LaSure to stop pending Medicare cuts to home health payments slated for 2027. In a letter cited by McKnights Home Care, the delegation argues the reductions threaten access to care, especially in rural and underserved areas. This political pressure highlights the ongoing tension between CMS's budget-neutral payment models and provider sustainability. While the appeal is specific to home health, it reflects broader congressional scrutiny of Medicare rate-setting that could influence future policy debates affecting all provider types. The CMS final rule on home health payments for 2027 will reveal whether this lobbying effort changes the agency's course.

Senator Josh Hawley (R-MO) introduced the Rural Emergency Medical Access Act to create a dedicated federal funding stream for emergency departments in rural hospitals at risk of closure. The bill aims to address what Hawley calls 'breakneck' closures that leave communities without emergency care. This legislation follows heightened scrutiny of the $50B Rural Health Transformation Fund, which some critics argue pushes hospitals to shrink rather than stabilize. The bill's introduction signals a congressional focus on rural hospital economics as closures accelerate; providers in rural areas should monitor its progress as a potential new revenue source for qualifying EDs.

North Carolina has begun enforcing Medicaid work requirements authorized under the 2025 reconciliation law, with state officials estimating more than 250,000 beneficiaries could lose coverage for non-compliance. This is the largest-scale implementation to date of the federal policy mandating work, volunteer, or training hours for certain Medicaid enrollees. Clinics in North Carolina should prepare for an influx of patients losing Medicaid coverage and needing to transition to other payers or become self-pay. Front desks must verify eligibility with increased frequency, and billing teams should model the revenue impact of a shrinking Medicaid population in their payer mix.