Centers for Medicare & Medicaid Services Archives - HIT Leaders and News

CMS Solidifies Rural Health Transformation Office, but Execution Risks Remain

Jason Free — Thu, 30 Apr 2026 20:16:36 +0000

The Centers for Medicare & Medicaid Services has formally established the Office of Rural Health Transformation (ORHT), a move that converts legislative momentum into structural commitment. As the operational steward of the $50 billion Rural Health Transformation (RHT) Program, launched under the Working Families Tax Cut legislation, the ORHT is now tasked with overseeing one of the most ambitious rural health efforts in U.S. history.

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ACA Enrollment Surges Past 22 Million, but Sustainability Questions Linger

Jason Free — Tue, 13 Jan 2026 23:53:20 +0000

The Centers for Medicare & Medicaid Services (CMS) recently announced that more than 22.8 million individuals have enrolled in 2026 health insurance coverage through Affordable Care Act (ACA) Marketplaces, a record-breaking figure that surpasses all previous enrollment periods. This national snapshot captures signups from both the federal HealthCare.gov platform and state-based exchanges (SBEs), marking a clear high point in the ACA’s implementation. But behind the headline growth lies a more nuanced, and increasingly urgent, set of questions for healthcare leaders tasked with navigating cost structures, compliance shifts, and continuity of care.

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Price Transparency Won’t Fix Health Care Until the Data Does

Jason Free — Mon, 22 Dec 2025 12:50:27 +0000

The latest proposed updates to federal price transparency regulations signal a deeper acknowledgment of an uncomfortable truth: health care pricing data is now technically public, but still functionally unusable. The Centers for Medicare & Medicaid Services (CMS), working with the Departments of Labor and Treasury, aims to correct this mismatch by simplifying data formats, reducing redundancies, and making cost tools more accessible. But unless these changes are paired with a broader shift in how price transparency is operationalized across the system, their impact may remain symbolic rather than structural.

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CMS Bets on Mandatory Drug Model to Break Medicare Part D Pricing Gridlock

Jason Free — Sun, 21 Dec 2025 11:54:25 +0000

The Centers for Medicare & Medicaid Services (CMS) has proposed a new mandatory payment model aimed at lowering prescription drug costs for Medicare beneficiaries, a move that underscores both the urgency and complexity of reforming drug pricing in the United States. Dubbed the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model, the initiative introduces international price benchmarking and modified rebate structures to rein in spending under Medicare Part D. But while the model reflects an aggressive policy posture, it also raises significant implementation and equity questions as it moves toward a 2027 launch.

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States Face Reckoning as CMS Targets Medicaid Tax Schemes

Jason Free — Mon, 17 Nov 2025 14:56:14 +0000

The Centers for Medicare & Medicaid Services (CMS) has issued preliminary guidance that signals a clear shift in how state Medicaid programs will be financed and monitored. With sweeping changes enacted under the Working Families Tax Cuts (WFTC) legislation (Public Law 119-21),

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Medicare Tightens Reimbursement with Precision Payment Reforms

Jason Free — Tue, 11 Nov 2025 12:58:08 +0000

The Centers for Medicare & Medicaid Services (CMS) has released its 2026 Medicare Physician Fee Schedule, introducing targeted reforms that reinforce CMS’ authority over how care is valued, reimbursed, and governed.

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Rural Health Gets a Rare Windfall, But Will $50 Billion Change the Math?

Jason Free — Mon, 22 Sep 2025 11:02:59 +0000

The Centers for Medicare & Medicaid Services (CMS) has unveiled the Rural Health Transformation Program, a $50 billion initiative that promises to remake the delivery landscape across rural America. Framed as a historic pivot and backed by the Working Families Tax Cuts Act, the program invites all 50 states to apply for a one-time infusion of funds designed to rebuild infrastructure, reimagine care delivery, and reverse generations of underinvestment.

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New Payment Caps Force States to Reevaluate Medicaid Managed Care Strategy

Jason Free — Mon, 15 Sep 2025 11:47:00 +0000

A shift in Medicaid financing policy is underway. The Centers for Medicare & Medicaid Services (CMS) has released preliminary guidance on new federal limits for State Directed Payments (SDPs), a move tied to the implementation of the One Big Beautiful Bill Act. Although the rule is not yet final, CMS is offering early instructions to help states prepare for significant restrictions on how managed care dollars can be directed.

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New Federal Rules Reshape the Clinical and Operational Realities of Real-Time Cost Data

Jason Free — Mon, 08 Sep 2025 11:07:45 +0000

For decades, price transparency at the point of care has been a policy aspiration more than an operational reality. But new regulatory changes finalized by the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) mark a shift from aspiration to enforceable expectation.

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CMS Launches AI-Powered Fraud Detection Challenge to Safeguard Medicare Integrity

Jason Free — Wed, 03 Sep 2025 11:39:12 +0000

The Centers for Medicare & Medicaid Services (CMS) has unveiled the "Crushing Fraud Chili Cook-Off Competition," a market-driven research initiative designed to leverage explainable artificial intelligence (AI) to identify fraud indicators and propose scalable solutions within the Medicare Fee-for-Service (FFS) program. The challenge invites innovative proposals that integrate machine learning (ML) with transparency and accountability, aiming to modernize fraud detection while preserving human oversight.

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