The model will leverage AI and machine learning for prior authorization of services vulnerable to fraud or inappropriate use, CMS says.

CMS has released a proposed rule on home health and DME that includes new policies for the next round of its national competitive bidding program. Those provisions include new rate-setting methodologi ...

CMS has unveiled the Wasteful and Inappropriate Service Reduction model, a new Innovation Center initiative that will add prior authorization for some traditional fee-for-service Medicare services.

“It’s the exact opposite of how we should be helping people,” said Lister. “We should aspire to provide health care services ...

The Trump administration aims to issue a rule empowering regulators to “forcefully” go after companies that don’t share drug ...

The go-broke dates for Medicare and Social Security’s trust funds have moved up as rising health care costs and new ...

The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees health coverage programs like Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

States are generally allowed to use Medicaid to cover emergency and lifesaving treatment for illegal immigrants, but CMS said it is cracking down on the practice of states using federal dollars to ...

A proposed regulatory change from the Centers for Medicare & Medicaid Services (CMS) aims to shut down a decades-old "tax loophole" in Medicaid financing, a move the agency says could save federal ...

Dual eligibility income thresholds for Medicaid and Medicare depend on how a person qualifies. Medicaid income limits are state-specific, but certain federal Medicare limits can still enable dual ...

Another proposal, “Limit Medicaid Provider Taxes” was given a $175 billion price tag over 10 years by decreasing the safe harbor threshold to 3% by 2028.