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 →
79 articles: 49 new or updated, 26 continuing, 4 closed.
All articles are listed below, including continuing and closed findings. The approved report also includes horizons, trends and implementation material.
79 articles shown, grouped by category.
Active high- and medium-priority findings, organized by topic.
Noridian’s September 24 MolDX revisions apply several October 1 diagnosis changes while preserving other revision-specific dates.
High priority · Oct 4, 2026 editionRead story →
AB 2499 requires electronic claim-support intake beginning May 26, 2028, with capacity, receipt and outage provisions.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s September 28 EDI replacement updates the 276/277 flat-file attachment while keeping October 1 effectiveness and October 5 implementation.
Medium priority · Oct 4, 2026 editionRead story →
AB 1126 limits excess Medi-Cal billing barriers after other coverage, with a Medicare exception and federal implementation conditions.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s September 29 IPPS/LTCH correction and replacement instruction require corrected FY 2027 files and October 5 implementation checks.
Medium priority · Oct 4, 2026 editionRead story →
CMS opened October 21 comment and reconsideration routes for preliminary 2027 laboratory payment determinations.
Medium priority · Oct 4, 2026 editionRead story →
The GLOBE final rule separates November 30 regulatory effectiveness, January manufacturer data collection and April 2027 performance and coinsurance changes.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s October 1 IPF correction lowers specified national payment amounts after wage-index recalculation.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s October 1 IRF correction revises the conversion factor, outlier threshold and related wage-based calculations.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s corrected FY 2027 hospice tables retain a 2.3-percent all-hospice impact estimate; the 20,000-or-more RHC-day subgroup shows 2.2 percent.
Medium priority · Oct 4, 2026 editionRead story →
CMS clarifies Medicare versus FEHBP payer order for specified retired federal compensation recipients, preserving separate workers-compensation rules.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s October 30 technical EDI manual update supports the TCEDI gateway and contractor responsibilities.
Medium priority · Oct 4, 2026 editionRead story →
CMS specifies home-health Grouper08.0.27 for qualifying January 2027 claim From dates, with January 4 implementation.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s January 2027 reference-file instructions distinguish ASP pricing, MPFS dataset readiness and quarterly ZIP-file updates.
Medium priority · Oct 4, 2026 editionRead story →
CMS instructs AHCAH telehealth billing to use inpatient POS21 with modifier95 because the patient remains an inpatient.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s September 30 SNF correction revises wage-based payment calculations and separate QRP burden estimates, effective October 1.
Medium priority · Oct 4, 2026 editionRead story →
Noridian’s October 1 notices separately update FFR codes, infusion-drug pricing, a SAD exclusion and diagnosis-code lists.
Medium priority · Oct 4, 2026 editionRead story →
DHCS’s October 1 notice extends state-only maintenance dialysis and associated transport for qualifying restricted-scope UIS members, with EPC processing planned.
Medium priority · Oct 4, 2026 editionRead story →
DHCS opens a limited September 29–November 29 waiver for qualifying unpaid RHC/FQHC LMFT and supervised psychological-associate claims.
Medium priority · Oct 4, 2026 editionRead story →
SB 1049 provides at least 90 calendar days for qualifying corrected claims after the carrier’s most recent action.
Medium priority · Oct 4, 2026 editionRead story →
AB 1629 establishes a conditional direct-payment pathway for assigned out-of-network dental benefits and related patient disclosures.
Medium priority · Oct 4, 2026 editionRead story →
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 · Oct 4, 2026 editionRead story →
Noridian’s finalized MolDX policies take effect October 12; the older thrombophilia LCD retires October 11, with distinct coverage and coding documents to prepare.
Medium priority · Oct 4, 2026 editionRead story →
AB 350 addresses fluoride varnish cost sharing for qualifying 2027 commercial coverage and directs broader Medi-Cal billing guidance.
Medium priority · Oct 4, 2026 editionRead story →
AB 1682 adds prescribed FDA-cleared scalp cooling coverage for qualifying large-group 2027 contracts and conditionally for Medi-Cal.
Medium priority · Oct 4, 2026 editionRead story →
CMS announced spring 2027 ACCESS expansion for additional chronic conditions under voluntary Original Medicare participation.
Medium priority · Oct 4, 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 · Oct 4, 2026 editionRead story →
SB 950 establishes 2027 coverage and step-therapy protections for qualifying FDA-approved memory treatments, with specified exceptions.
Medium priority · Oct 4, 2026 editionRead story →
AB 1843 restricts prior authorization for medically necessary hepatitis C direct-acting antivirals, with a therapeutic-equivalent exception.
Medium priority · Oct 4, 2026 editionRead story →
AB 1887 sets a 30-day backstop and immediate-approval consequence for narrowly qualifying rare-disease drug requests under affected 2027 coverage.
Medium priority · Oct 4, 2026 editionRead story →
SB 964 creates a conditional 72-hour written-response pathway for dose or frequency adjustments to previously approved serious-condition treatment.
Medium priority · Oct 4, 2026 editionRead story →
SB 1094 changes biosimilar substitution and 2027 formulary rules while conditioning carrier-directed switches on notice, cost and continuity safeguards.
Medium priority · Oct 4, 2026 editionRead story →
AB 1906 addresses 2027 cervical screening and self-collection coverage, with commercial scope and conditional Medi-Cal requirements.
Medium priority · Oct 4, 2026 editionRead story →
AB 280 sets July 1, 2027 provider-directory utility and reliance requirements, with product and hospital exceptions.
Medium priority · Oct 4, 2026 editionRead story →
AB 1876 enacts specific nondiscrimination protections for health coverage while preserving legitimate nondiscriminatory coverage decisions.
Medium priority · Oct 4, 2026 editionRead story →
DHCS’s September 30 letter sets October 13 reimbursement limits for specified youth gender-affirming services, with an existing-hormone transition and continuing ancillary-care duties. Managed care plans must address member notices, care coordination and policy updates; the guidance does not permit blanket cancellation of care.
High priority · Oct 4, 2026 editionRead story →
California’s coalition challenged the October 13 Medicaid/CHIP funding rule; the rule and lawsuit have different legal effects, with a limited hormone-therapy transition.
Medium priority · Oct 4, 2026 editionRead story →
CMS reported universal state applications to GENEROUS and a September 30 agreement deadline; applications did not establish every state’s signed status.
Medium priority · Oct 4, 2026 editionRead story →
DHCS’s September 29 transition notice highlights fee-for-service enrollment and billing readiness for affected UIS members before January 1.
Medium priority · Oct 4, 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 · Oct 4, 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 · Oct 4, 2026 editionRead story →
ORR corrects refugee cash and medical assistance eligibility to twelve months and directs recipients to implement within thirty days.
Medium priority · Oct 4, 2026 editionRead story →
AB 2348 adds Medi-Cal ECM and community-support reporting, guidance and provider-education requirements while preserving conditional program scope.
Medium priority · Oct 4, 2026 editionRead story →
Every new hospice election from October 1 requires a written election-statement addendum, furnished within five calendar days. CMS also requires timely updates and a valid signed record. October–December enforcement discretion concerns claim denials for missing or incomplete addenda; it does not make the document optional.
High priority · Oct 4, 2026 editionRead story →
CMS seeks October 26 comments on proposed annual hospital-at-home service reporting; the collection remains an OMB-approval request as of October 4.
Medium priority · Oct 4, 2026 editionRead story →
Medi-Cal’s first quarterly directory-validation window opened October 1; all survey questions must be saved within 45 days to protect organizational Transaction Center access.
Medium priority · Oct 4, 2026 editionRead story →
The September 1 Medi-Cal notice requires FFS hospice election attestations through the Provider Portal within five calendar days, with signed consent retained in the record.
Medium priority · Oct 4, 2026 editionRead story →
CMS published the final 2027 mandatory Ambulatory Specialty Model participant list and highlighted reporting and attestation duties.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s November manual update incorporates existing allowed-practitioner home-health certification authority and preserves eligibility-documentation requirements.
Medium priority · Oct 4, 2026 editionRead story →
Noridian explains how an IRF ownership change affects RCD choices, affirmation history and portal/UTN identifiers.
Medium priority · Oct 4, 2026 editionRead story →
CMS’s October 1 reminder addresses duplicate lab tests and medically necessary repeats, alongside an earlier $1.6 billion integrity total that mixes several kinds of action.
High priority · Oct 4, 2026 editionRead story →
OIG identified $72 million in Medicare Advantage and Part D payments associated with 249 revoked NPIs absent from the Preclusion List. The brief describes timing, ownership and pharmacy-related gaps. It issues no specific recommendations and does not classify every payment as proven fraud.
High priority · Oct 4, 2026 editionRead story →
OIG found $587.7 million in 2021–2023 Part D payments for five drugs sold with obsolete prescription-only labels after their brand counterparts switched to OTC.
Medium priority · Oct 4, 2026 editionRead story →
OIG estimated $380 million for organ-acquisition costs outside Medicare-covered transplants and separately recommended recovering $154,210 for undocumented organ counts.
Medium priority · Oct 4, 2026 editionRead story →
CMS released the Q2FY2026 short-term acute-care PEPPER report with organization-approved portal access.
Medium priority · Oct 4, 2026 editionRead story →
DOJ’s October 1 corporate-fraud directive identifies healthcare priorities and prosecutor procedures, not a new provider self-report deadline.
Medium priority · Oct 4, 2026 editionRead story →
Lower-priority and watch items, plus closed matters kept for the edition record.
Medium priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Medium priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
High priority · Oct 4, 2026 editionRead story →
High priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
Lower priority · Oct 4, 2026 editionRead story →
No articles in this topic. Choose All topics to return to the complete edition.