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Medicare & Medicaid · Sep 6, 2026

The complete edition, organized by topic. Every published finding remains available.

Archived edition. This edition reflects its original coverage dates and may not reflect current requirements. Read the latest edition →

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25 articles: 19 new or updated, 6 continuing, 0 closed.

All articles are listed below, including continuing and closed findings. The approved report also includes horizons, trends and implementation material.

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25 articles shown, grouped by category.

Higher-priority matters

Active high- and medium-priority findings, organized by topic.

Billing & payment 5 articles

Billing & paymentMedicare & MedicaidContinuing

Medi-Cal requires quarterly validation of the public fee for service provider directory beginning October 1, 2026, with Provider Portal Transaction Center access at stake

DHCS’s August 26 notice requires quarterly validation of the public fee-for-service provider directory starting October 1. Administrators have a forty-five-day window and must save completed survey responses; missed updates affect every user’s Transaction Center access in the organization.

Medium priority · Sep 6, 2026 editionRead story →

Billing & paymentMedicare & MedicaidNew in this edition

AB-2499 Health care coverage: claims payments

Pending AB 2499 would require standard electronic supporting-document submission from May 26, 2028, including receipt confirmation and protections against system-only claim delays.

Medium priority · Sep 6, 2026 editionRead story →

Billing & paymentMedicare & MedicaidNew in this edition

AB-2571 Reimbursement for pharmacist services

Pending AB 2571 would expand pharmacist payment routes and advanced-practitioner reimbursement, with distinct commercial, Medi-Cal and FQHC/RHC conditions.

Medium priority · Sep 6, 2026 editionRead story →

Coverage & clinical policy 5 articles

Coverage & clinical policyMedicare & MedicaidNew in this edition

AB-280 Health care coverage: provider directories

Pending AB 280 proposes a central provider-directory utility, common standards and reasonable-reliance protections, with specific integrated-plan and Medi-Cal scope exceptions.

Medium priority · Sep 6, 2026 editionRead story →

Coverage & clinical policyMedicare & MedicaidNew in this edition

AB-350 Health care coverage: fluoride treatments

Pending AB 350 addresses medically necessary fluoride varnish across medical and dental billing and proposes Medi-Cal guidance for members under twenty-one, with training and federal conditions.

Medium priority · Sep 6, 2026 editionRead story →

Coverage & clinical policyMedicare & MedicaidNew in this edition

AB-1682 Health care coverage: scalp cooling

Pending AB 1682 would cover prescribed FDA-cleared scalp cooling for chemotherapy-related hair loss in large-group coverage and conditionally in Medi-Cal.

Medium priority · Sep 6, 2026 editionRead story →

Coverage & clinical policyMedicare & MedicaidNew in this edition

AB-1876 Health care coverage: nondiscrimination

Pending AB 1876 would strengthen plan and insurer nondiscrimination provisions and grievance notices while preserving legitimate, nondiscriminatory clinical and coverage decisions.

Medium priority · Sep 6, 2026 editionRead story →

Medicare Advantage & Part D 3 articles

Medi-Cal & Medicaid policy 2 articles

Medi-Cal & Medicaid policyMedicare & MedicaidNew in this edition

AB-220 Medi-Cal: subacute care services

Pending AB 220 would limit extra pediatric subacute criteria and duplicate authorization forms, with specific protections for return from an acute-hospital bed hold.

Medium priority · Sep 6, 2026 editionRead story →

Provider operations 1 articles

Audits & program integrity 1 articles

Audits & program integrityMedicare & MedicaidContinuing

CMS reports $1.6 billion in Medicare laboratory program integrity actions across revocations, suspensions, recoupments and referrals

CMS’s August 28 laboratory announcement combines projected savings, suspended payments, recoupments and referral-related prevention. Its examples describe rapid billing intervention, but the headline total is not a single recovered sum or an adjudication that every associated claim was fraudulent.

High priority · Sep 6, 2026 editionRead story →

More matters and continuing watch

Lower-priority and watch items, plus closed matters kept for the edition record.

Billing & payment 4 articles

Coverage & clinical policy 1 articles

Medicare Advantage & Part D 1 articles

Provider operations 2 articles

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