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On September 9, 2026, the FTC rescinded its 2021 Policy Statement on Breaches by Health Apps and Other Connected Devices. The rescission does not exempt health apps from the Health Breach Notification Rule. The FTC's 2024 final HBNR rule remains in effect and expressly addresses health apps, related technologies, and unauthorized disclosures of covered health information. The immediate vendor-contract task is not to remove unauthorized-sharing obligations; it is to distinguish contractual references to the withdrawn 2021 statement from obligations that remain grounded in the 2024 rule and applicable state law.
Read More →EMTALA citation rates climbed from 4% of inspections in 2019 to 6.9% in 2024, concentrated in three categories: medical screening exams, appropriate transfers, and general EMTALA requirements. A July 2026 CMS proposed rule would add accreditor review of EMTALA administrative requirements to routine surveys — shifting the enforcement trigger from complaint to calendar, if finalized.
Read More →MedPAC's September 4 presentation on plan-level MA risk adjustment accuracy shifts the analytical frame from a single aggregate overpayment figure to plan-by-plan examination. The aggregate number produced a program-wide V28 recalibration whose financial effect varied by plan. A plan-level finding, if it leads to policy, would not be symmetric — and it arrives as major MA sponsors tell investors 2027 is a margin-repair year.
Read More →The White House's $500 ACA user-fee refund is expected to be paid to nearly one million current unsubsidized HealthCare.gov enrollees in 30 states. For hospital finance teams, the refund is a rounding error. The real 2027 budget variable is HCA's H1 data showing a material payer-mix shift associated with Marketplace coverage losses at rates the industry had not fully modeled.
Read More →MedPAC's September 4 presentation compared post-acute care utilization across 25.6 million FFS and 27.8 million MA beneficiaries. MA home health visit-days ran 20% lower. That difference is now Commission-documented preliminary analysis, and it belongs in your next peer-to-peer — used carefully.
Read More →Louisiana’s Medicaid managed care contract with Healthy Blue ends December 31, 2026, redistributing more than 290,000 members to four remaining plans on January 1. Five days earlier, Indiana put roughly $68 billion in Medicaid managed care contracts out to bid across four programs and more than 1.4 million members, with contracts effective January 1, 2029. Read together, the two events describe the current posture: plans are making state-specific decisions based on rate adequacy, contract structure, and integration economics.
Read More →For Medicare Advantage organizations and state Medicaid and CHIP fee-for-service programs, January 1, 2027 is the compliance date for the Provider Access, Payer-to-Payer, and Prior Authorization APIs under CMS-0057-F. One runs on patient opt-out and one on patient opt-in, which means one will carry real volume on day one and the other almost certainly will not. Four months out, the useful work for a provider organization is a test plan that separates endpoint availability from data completeness.
Read More →CMS’s CY 2027 OPPS proposed rule would implement Section 6225 of the Consolidated Appropriations Act, 2026: every off-campus hospital outpatient department needs its own NPI and a filed provider-based attestation, or Medicare payment is unavailable for services furnished by that department beginning January 1, 2028. The same rule proposes moving imaging without contrast to physician-office rates in excepted off-campus departments — the third service family in three years. The compliance project and the erosion of what it protects are running on the same clock.
Read More →This was the week the $50 billion Rural Health Transformation Program stopped being a state allocation and started being line items — ambulances in Hawaii, telehealth in Arkansas, worksite clinics in West Virginia. Nearly all of it buys equipment and buildings. The operational question that hasn't been answered is whether the facility has the workforce and recurring resources to make the equipment useful on the shifts when it is needed.
Read More →Plans must deliver Annual Notice of Change packets to current enrollees by September 30 and non-renewal notices on required timelines, which means the first wave of plan-exit calls reaches case management inside four weeks. The reflex answer — they are going back to Traditional Medicare, so the plan's prior-authorization process goes away — is incomplete in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, where the WISeR Model applies prior authorization or prepayment review to selected services in fee-for-service Medicare.
Read More →ONC finalized updated versions of seven FHIR implementation guides — CRD, DTR, PAS, CARIN for Blue Button, PDex US Drug Formulary, PDex Plan Net and CDex — in the FY2027 IPPS final rule, effective October 1, 2026. They replace the versions adopted last year in HTI-4. The provisions were proposed in CMS-0062-P, which is still proposed, which means the standards for a rule that is not final were adopted through a rule that is.
Read More →On August 19, CMS published a Privacy Act system-of-records notice establishing the Nurses for Nursing Homes Program — licensure records, facility affiliation, payment and tax data on participating nurses. It is the paperwork that proves a program is running. The sequence is what matters: the federal minimum staffing standard was repealed effective February 2026 and barred from enforcement until 2034, and what replaced it pays an individual nurse to sign a three-year commitment.
Read More →CMS set the CY2027 Part D national average monthly bid amount at $296.05, up 23.7% from $239.27, while the base beneficiary premium rose 6.0% to $41.33 — precisely the IRA statutory cap. The gap between those two growth rates is the story, and the Premium Stabilization Demonstration that has been absorbing it since 2025 ends December 31. Landscape files in mid-to-late September are the first clean read.
Read More →The CY2027 OPPS proposed rule pairs two 340B actions that have to be modeled together: repricing 340B-acquired drugs at ASP minus 33.4%, worth $4.55 billion in reduced Original Medicare drug payment, and raising the November 2023 remedy offset from 0.5% to 3% of the non-drug conversion factor. Because the first is statutorily budget neutral and the second is not, the net depends entirely on the ratio of your 340B drug revenue to your non-drug OPPS volume.
Read More →CMS has proposed removing 638 services from the Inpatient Only list for CY2027, the second year of a three-year phase-out. For utilization management, the consequential detail is not the site-of-service flexibility CMS describes — it is that 42 CFR 422.101(b)(2)(iii) requires Medicare Advantage plans to cover an inpatient admission when the procedure is on the IPO list. Take the code off the list and that pathway closes.
Read More →Centene named Chris Neczypor CFO effective January 1, 2027, succeeding Drew Asher, who steps down December 31 and retires at the end of 2027. The date is the story: Neczypor takes the chair on the first day of a year with no 2025 settlement tailwind, a Medicaid book guided down 8–9%, and post-subsidy-cliff exchange economics. An outside hire from life and annuities reads as a capital-allocation mandate, not an operating one.
Read More →ONC awarded The Sequoia Project its next TEFCA RCE option year with a 15%-plus funding increase, on numbers that look like escape velocity: 11 QHINs, 23,000-plus organizations, 100,000-plus sites, 1.5 billion documents. Payers face a January 1, 2027 deadline for four FHIR APIs under CMS-0057-F. These are different problems with different stacks, and nothing in CMS's rule treats participation in one as compliance with the other.
Read More →Fitch's 2026 medians put the nonprofit hospital operating margin at 1.5% on audited FY2025 financials, up from 1.1%. Personnel expense fell 90 basis points as a share of operating revenue over the same period-meaning the entire margin gain, and then some, came out of the labor line. Fitch calls FY2025 a brief operational peak. Here is what that sequence implies for FY2027 modeling.
Read More →The first Rural Health Transformation awards are landing in facilities now. Contrary to the common read, personnel costs are allowable - clinician salaries can be funded under an approved workforce initiative. The binding constraint is structural: funds must be obligated inside a single budget period, salary and fringe must be spent in the period incurred, and the whole appropriation ends after FY2030. Meanwhile the clinician you recruit may owe five years of rural service.
Read More →CMS has updated its prior authorization metrics reporting overview and template, closing the loophole that let payers bury denial data behind passwords and unlinked pages. The data are real and newly comparable - but they are reported at the MA contract level, exclude drugs, and carry no numerators. Here is what a physician advisor can actually operationalize from a published overturn rate, and where it will mislead you.
Read More →CMS-0057-F requires impacted payers to implement a Prior Authorization API by January 1, 2027. The required standard is FHIR R4.0.1. The Da Vinci PAS Implementation Guide STU 2.0.1 — the spec that makes those endpoints interoperable — is listed under “Recommended Implementation Guides.” Recommended is not required. A compliant payer in January 2027 can build a proprietary schema that forces every EHR vendor to write bespoke integration logic. The administrative friction doesn’t disappear; it moves from the fax machine to the integration layer. The first public PA metrics (March 2026) showed 50.2 million MA determinations, a 7.7% denial rate, and 80.7% of appealed denials overturned. Faster and electronic doesn’t fix that.
Read More →Rankin County Hospital District has 15 beds. It sits in Rankin, Texas — population 730. The hospital is a critical access facility, exempt from TEAM, the mandatory bundled-payment model CMS launched in January for nearly 750 acute-care hospitals. Rankin’s swing-bed program has been running the post-acute coordination TEAM is now mandating at scale for years. When a patient no longer needs acute care but isn’t ready to go home, the bed changes reimbursement category. Physical and occupational therapy come to them. Family stays close instead of driving an hour each way. Worth noticing where the model already exists: small, local, quietly working.
Read More →UNH Q2 2026: $5.5B profit on $112B revenue, up from $3.4B Q2 2025. H1 profit $11.8B vs. $9.7B H1 2025. Every major managed care insurer reported a Q2 profit. Centene swung to ~$1.1B from a prior-year loss and raised 2026 EPS guidance for the second time — but still below 2023–24 levels. CVS $3B on $106B, Elevance $1.7B, Cigna $1.5B. The divergence: Humana held guidance rather than raised. Q2 benefit ratio 91.2%, FY adjusted EPS at least $9, but that implies a YoY decline because of Star Ratings headwinds. Q3 will get read for what it says about 2027 more than the back half of 2026.
Read More →The 340B Drug Pricing Program moved roughly $100 billion in 2025 — nearly double 2022’s $53.7 billion. Two policy moves converge January 1, 2027, and 340B-participating CFOs have one quarter left to model both. HRSA authorized the revised 340B Rebate Model Pilot Program on July 31, 2026: providers pay WAC upfront on covered drugs, then wait for post-dispense rebate. CMS’s proposed 2027 OPPS rule would cut Medicare reimbursement for 340B drugs from ASP+6% to ASP-33.4%. The redistribution runs against safety-net hospitals (-5.8% net OPPS revenue) and toward for-profits (+7.4%). For DSH-heavy systems already carrying 2025 Medicaid exposure, this is a Q3 modeling job.
Read More →A 71-year-old patient shows up for nephrology follow-up on January 5 [composite scenario]. Her MA plan had approved the renal imaging workup but she disenrolled to Traditional Medicare on January 1. The prior auth is gone. The 90-day continuity-of-care protections run MA to MA — not MA to Traditional Medicare. Inside 48 hours: prior auth structures disappear, network rules change, supplemental benefits end. For physician advisors, this becomes a documentation problem long before it becomes a denial problem.
Read More →Workplace cliques in hospital social work can lead to isolation, reduced collaboration, and lower job satisfaction by creating silos and hindering effective teamwork. The blog post offers strategies such as focusing on professional growth, building relationships across disciplines, communicating with management, and promoting inclusivity to create a more supportive and unified work environment.
Read More →Ensuring quality care in long-term care (LTC) facilities just got a significant boost as the Centers for Medicare & Medicaid Services (CMS) finalizes new staffing recommendations.
Read More →Prolonged hospital stays not only strain healthcare resources but also deeply impact the mental and emotional well-being of both patients and their caregivers.
Read More →Prolonged hospital stays not only strain healthcare resources but also deeply impact the mental and emotional well-being of both patients and their caregivers.
Read More →Every day, hospitals grapple with resource over-extension, leading to prolonged patient stays and strained healthcare systems.
Read More →Every day, hospital case managers face heart-wrenching ethical dilemmas that can lead to profound moral distress and even moral injury.
Read More →For when your health system has been locked down due to a cyber attack.
Read More →How well do you know the resources available for your patients?
Read More →Discover how leveraging publicly available information can enhance patient care, streamline resource identification, and elevate your ability to coordinate comprehensive treatment plans in today's digital healthcare landscape.
Read More →Ghost Networks, a healthcare system where patients are led down endless paths to nonexistent providers, and doctors find themselves invisible to those seeking their care.
Read More →In this post, we explore strategies for case managers to integrate palliative care principles early in patient care in resource-constrained settings.
Read More →Sixteen tiles, four hidden groups of four, all drawn from discharge planning, utilization review and post-acute care. Four wrong guesses and the board wins. New puzzle every day.
Six letters, six guesses, and every answer is a word out of your working day — revealed at the end with a line about what it actually means on the floor.
Match ambulances, beds, charts, meds and phone calls to break down the fifteen things standing between your patient and the door — before the days run out.
Navigate a 3D care environment to uncover hidden discharge barriers. Resolve five real-world cases — SNF, Home Health, Rehab, LTC, and Hospice — before time runs out.
Race against the clock to find the right level of care for five different patients before discharge deadlines hit.
When the answer is unclear, shake the ball. Healthcare-themed wisdom (and sarcasm) for the toughest discharge dilemmas.
Classic Sudoku with a case management twist. Three difficulty levels — perfect for a focused mental reset between cases.
You're the case manager. Navigate impossible barriers, advocate for your patient, and get them safely discharged before time runs out.