CMS

States are turning to the big health insurance companies to keep Medicaid enrollees insured once pandemic protections end in April. The insurers’ motive: profits.

Designed to prevent doctors from deploying expensive, ineffectual procedures, preauthorization has morphed into a monster that denies or delays care, burdens physicians with paperwork and perpetuates racial disparities.

A new rural hospital payment model shifts the focus of services away from overnight stays to outpatient and emergency care. Still, experts say the law needs to be amended to provide the right mix of care for rural communities.

Depending on where they lived, demands for repayment can drain the assets that a patient on Medicaid leaves behind after they die. Iowa aggressively collects "clawback" funds.

Florida was among three states that declined to check for vaccination violations, instead leaving that process to CMS, which hired contractors. As a result, CMS said Florida was docked more than $1.2 million.

Politicians are again pointing fingers over cutting Medicare. Any party accused of threatening the program tends to lose elections, but without a bipartisan agreement, seniors stand to lose the most.

Drugmakers will be required to pay Medicare back for price increases that outpace inflation. The industry is expected to put up a fight over implementation.

Kaiser Health News has released never-before-seen details of federal audits as the government weighs action against dozens of Medicare Advantage plans.

The Centers for Medicaid & Medicare Services gives facilities an overall star rating along with details on health care, staffing and quality at its Care Compare website.

The investigations into select nursing homes are aimed at verifying whether patients have been properly diagnosed with the psychiatric disorder.