Over the past decade, remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) have transformed from emerging technologies into integral components of chronic disease management. Fueled by advances in connected medical devices, wearable sensors, digital therapeutics, artificial intelligence (AI), and virtual care platforms, remote monitoring has expanded providers' ability to manage patients beyond the traditional clinical setting while supporting earlier intervention and improved
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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
CMS Releases FY 2027 IPPS and LTCH PPS Final Rule: Rates, Mandatory CJR-X Model, and EHR Changes
What You Should Know
The Centers for Medicare & Medicaid Services (CMS) issued its FY 2027 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS final rule, enacting a 2.3% net payment rate increase for both IPPS acute care hospitals and LTCHs.The rule mandates nationwide expansion of the Comprehensive Care for Joint Replacement (CJR) Model—dubbed CJR-X—beginning January 1, 2028, covering hip, knee, and ankle replacements across inpatient and hospital
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RWJF Report Analyzes Hospital Financial and Workforce Strains Under OBBBA
What You Should Know
A joint report by the Urban Institute and Robert Wood Johnson Foundation analyzes five major federal policy shifts threatening hospital financial stability and operational sustainability.Medicaid work requirements and semi-annual redeterminations under the One Big Beautiful Bill Act (OBBBA), combined with ACA Marketplace subsidy expirations, are projected to cause millions to lose health coverage.State-Directed Payment caps and provider tax reductions under OBBBA will cut
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HHS and CMS Defer $1B in Federal Medicaid Payments to California and Minnesota
What You Should Know
CMS has deferred approximately $867.5M in federal Medicaid payments to California and $199M to Minnesota while requiring additional supporting documentation for high-risk claims.The deferred amounts represent temporary funding holds rather than permanent cuts, granting both states an official review window to submit valid proof of compliance with federal Medicaid regulations.Under HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz, federal oversight
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The Hidden Risk in CMS Compliance: Why Health Plans Can’t Treat Prior Authorization APIs and Claims Attachments as Separate Projects
Most health plans approach regulatory deadlines in a sequential order. They establish separate implementation strategies and initiatives, prioritizing each program based on the looming compliance date. While this methodology is understandable, it also introduces inherent risks for rules that share workflow, data, governance and vendor dependencies. The uncertainty is not technical incompatibility, but rather organizational separation.
This concern is top of mind for healthcare organizations
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No Surprises Act Reform: What the Latest IDR Changes Mean for Laboratories and Diagnostic Providers
When Congress enacted the No Surprises Act (NSA), the primary objective was straightforward: protect patients from unexpected out-of-network medical bills. Since implementation in 2022, however, the law has created a complex framework for resolving payment disputes between providers and payors through the Federal Independent Dispute Resolution (IDR) process.
What began as a well-intentioned arbitration mechanism has evolved into a system burdened by millions of disputes, operational
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How the REAL Health Providers Act Will Eradicate “Ghost Networks”
The proposed Requiring Enhanced and Accurate Lists (REAL) Health Providers Act—also referred to as the RHP Act—recently signed and expected to take effect for plan year 2028, represents a significant shift in how healthcare providers are regulated, credentialed, and represented to Medicare Advantage members.
The proposed requirements aim to provide health plan members with greater transparency, accessibility, and accuracy within provider directories in their member portals. Payers will need
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When Rural Maternity Care Fails: Why Bipartisan Policy Must Stabilize Obstetric Infrastructure
More than one-third of U.S. counties are now considered maternity care deserts. In 2023, the national maternal mortality rate hit 18.6 deaths per 100,000 live births. For Black women, that climbs to 50.3 deaths per 100,000, more than double the national average.
What we're missing is policy alignment, sustainable funding, and important culture changes that align maternal care teams beyond the current boundaries of what high quality and reliable maternal care looks like. And we can’t
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Building Bridges: Academic-Practice Partnerships as the Future of New Graduate Nurse Preparedness
Building Bridges: Academic-Practice Partnerships as the Future of New Graduate Nurse Preparedness
The nursing workforce is at an inflection point. As experienced nurses retire or leave the profession and care delivery continues to shift in complexity, health systems are increasingly dependent on new graduate nurses to sustain operations, ensure patient safety, and deliver high‑quality care. Many organizations are finding that today’s graduates are entering practice underprepared for the
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UnitedHealthcare to Eliminate 30% of Prior Authorizations by Year-End: A Strategic Shift Toward Transparency and Rural Support
What You Should Know
UnitedHealthcare (UHC) will eliminate an additional 30% of prior authorization requirements by the end of 2026, targeting outpatient surgeries, diagnostic tests (like echocardiograms), and chiropractic care.The initiative aims to reduce administrative friction, as 92% of current authorizations are already approved, typically in under 24 hours.UHC is expanding its National Gold Card Program, which exempts provider groups with proven track records of evidence-based care
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