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 →
40 articles: 4 new or updated, 34 continuing, 2 closed.
All articles are listed below, including continuing and closed findings. The approved report also includes horizons, trends and implementation material.
40 articles shown, grouped by category.
Active high- and medium-priority findings, organized by topic.
CMS’s revised October NCD coding instructions remove the stem-cell changes for a later April 2027 request. October 5 implementation remains scheduled for the retained coding updates, including some earlier effective dates. CMS distinguishes these maintenance changes from new coverage policy.
High priority · Sep 27, 2026 editionRead story →
Noridian’s September 24 MolDX notices announce October diagnosis-code changes and separately dated revisions. Article maintenance does not itself establish coverage for every listed test.
High priority · Sep 27, 2026 editionRead story →
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 27, 2026 editionRead story →
OIG separates an estimated $380 million organ-counting policy conflict from $154,210 in specifically unsupported reimbursement. The findings call for different policy and documentation responses.
Medium priority · Sep 27, 2026 editionRead story →
Medi-Cal’s September 1 hospice notice separates the five-calendar-day portal attestation from the signed election form, which stays in the member’s medical record.
Medium priority · Sep 27, 2026 editionRead story →
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 27, 2026 editionRead story →
Pending AB 2571 would expand pharmacist payment routes and advanced-practitioner reimbursement, with distinct commercial, Medi-Cal and FQHC/RHC conditions.
Medium priority · Sep 27, 2026 editionRead story →
CMS reports applications from every state, DC and Puerto Rico, but fewer signed GENEROUS agreements. The September 30 signing date remains ahead; applications alone do not establish each state’s participation terms.
Medium priority · Sep 27, 2026 editionRead story →
AB 1126 limits excess Medi-Cal billing barriers after other coverage, with a Medicare exception and federal implementation conditions.
Medium priority · Sep 27, 2026 editionRead story →
DHCS’s September stakeholder notice prepares a January 1 managed-care-to-fee-for-service transition for specified members. It points to readiness meetings and member and provider resources.
Medium priority · Sep 27, 2026 editionRead story →
CMS opened October 21 comment and reconsideration routes for preliminary 2027 laboratory payment determinations.
Medium priority · Sep 27, 2026 editionRead story →
DHCS’s psychiatric emergency payment draft seeks October 12 feedback and distinguishes emergency care from admitted inpatient psychiatric specialty services.
Medium priority · Sep 27, 2026 editionRead story →
Noridian’s August 27 notices finalize two MolDX policies for October 12 and retire the older thrombophilia policy October 11. Coverage remains conditional on each policy’s clinical and testing criteria; a test’s name alone does not establish coverage.
Medium priority · Sep 27, 2026 editionRead story →
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 27, 2026 editionRead story →
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 27, 2026 editionRead story →
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 27, 2026 editionRead story →
Pending AB 1876 would strengthen plan and insurer nondiscrimination provisions and grievance notices while preserving legitimate, nondiscriminatory clinical and coverage decisions.
Medium priority · Sep 27, 2026 editionRead story →
Noridian’s September 17 JE notices set a nerve-policy transition and separate facet-joint coding and MolDX hyperlink revisions.
Medium priority · Sep 27, 2026 editionRead story →
OIG attributes $587.7 million in ineligible Part D payments to obsolete prescription labeling and oversight gaps. The audit recommends a sponsor-rejection timeframe; it does not itself impose a universal new cutoff.
Medium priority · Sep 27, 2026 editionRead story →
California’s September 2 lawsuit challenges October 13 Medicaid and CHIP reimbursement restrictions. The filing seeks relief; it does not itself suspend the rule or establish a later court outcome.
Medium priority · Sep 27, 2026 editionRead story →
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 27, 2026 editionRead story →
CMS is proposing an annual hospital-at-home services collection, with comments due October 26. The new CMS-10971 tool would describe clinician visits, food and pharmacy services; the notice seeks OMB approval and does not itself establish an approved reporting start date.
Medium priority · Sep 27, 2026 editionRead story →
CMS announced spring 2027 ACCESS expansion for additional chronic conditions under voluntary Original Medicare participation.
Medium priority · Sep 27, 2026 editionRead story →
The September 18 EDI transmittal replaces the August version to correct two 276/277 spreadsheet errors; systems implementation remains October 5.
Medium priority · Sep 27, 2026 editionRead story →
CMS published the final 2027 mandatory Ambulatory Specialty Model participant list and highlighted reporting and attestation duties.
Medium priority · Sep 27, 2026 editionRead story →
CMS’s September 11 instructions align FY 2027 inpatient rates, Grouper/MCE 44.0, Pricers and provider files with October 1 discharges and October 5 implementation.
Medium priority · Sep 27, 2026 editionRead story →
DHCS’s ACWDL 26-16 restores January 2027 asset tests for specified groups with application, renewal, cure and transfer-review protections.
Medium priority · Sep 27, 2026 editionRead story →
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 27, 2026 editionRead story →
Lower-priority and watch items, plus closed matters kept for the edition record.
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