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Health Insurance

Morgan Lewis

CMS Launches $50B Rural Health Transformation Program

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The Centers for Medicare and Medicaid Services recently announced its award decisions for the Rural Health Transformation Program, established as part of the One Big Beautiful Bill Act, and provided a summary of each state...more

McDermott+

Healthcare Preview for the Week of: February 9, 2026

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This week, congressional attention will be mainly on funding for the US Department of Homeland Security (DHS) for fiscal year (FY) 2026, which is set to expire this Friday....more

King & Spalding

CMS Announces Changes to CY 2027 Medicare Advantage Capitation Rates and Part D Payment Policies

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On January 26, 2026, CMS released its Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Advance Notice). The Advance...more

Polsinelli

OIG’s New Medicare Advantage Program Compliance Guidance: What Providers Need to Know

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Key Takeaways - OIG’s new Medicare Advantage Industry Segment-Specific Compliance Program Guidance (MA ICPG) highlights major compliance risk areas and provides practical guidance for MA plans and other parties....more

Akerman LLP - Health Law Rx

The No Surprises Act: Key Developments to Watch in 2026

As the No Surprises Act (NSA) enters 2026, federal agencies are expected to focus on three key issues: finalizing delayed rulemaking, issuing guidance to address operational challenges in the Independent Dispute Resolution...more

Sheppard Mullin Richter & Hampton LLP

Healthy AI: 2025 Year in Review

Artificial intelligence (AI) in healthcare may have reached an inflection point in 2025. After being defined by proofs of concept and isolated pilots for more than a decade, recent advances signal that AI is moving decisively...more

Morgan Lewis - Health Law Scan

Medicare Advantage Agent and Broker Agreements: 2025 in Review

2025 was an important year for Medicare Advantage (MA) plans that pay state-licensed agents and brokers to market their plans and engage in lead generation, subject to complex federal regulations. As we previously discussed...more

Bass, Berry & Sims PLC

From 1999 to Prime Time: OIG Revamps Medicare Advantage Guidance for Today’s—and Tomorrow’s—Evolving Market

On February 3, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued new Medicare Advantage Industry Segment-Specific Compliance Program Guidance (MA ICPG) for the MA industry and...more

DLA Piper

CMS proposes to exclude unlinked diagnoses from Medicare Advantage risk adjustment: An opportunity for plan-provider value-based...

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The Centers for Medicare & Medicaid Services (CMS) published its “Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies” on...more

Alston & Bird

President Signs 2026 Spending Package to End Brief Shutdown; Trump Administration Launches TrumpRX

Alston & Bird on

On February 2, 2026, the Health Resources and Services Administration (HRSA) released a request for public comment entitled, Request for Public Comment on the Updated Criteria for Determining Maternity Care Health...more

Mintz - Health Care Viewpoints

Congress Passes Landmark PBM Reform in 2026 Spending Bill

On February 3, 2026, Congress passed – and the President signed – the Consolidated Appropriations Act, 2026 (2026 CAA). The legislation includes a long‑anticipated and far‑reaching package of PBM reforms. These reforms draw...more

Mintz - ML Strategies

2026 US Health Care Policy Outlook: Affordability Pressures, TrumpRx, and ACA Uncertainty

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Health care policy will be at the center of Washington’s agenda in 2026. The midterm elections this November are already shaping the federal landscape and influencing Congress’s priorities. Affordability remains a top voter...more

Groom Law Group, Chartered

Drug Pricing and Plan Contracting Practices Under Scrutiny: PBM and TPA Reforms in the Consolidated Appropriations Act, 2026

On February 3, 2026, Congress passed and the President signed the Consolidated Appropriations Act, 2026 (“CAA 26”), a legislative package that funds several federal agencies, including the Departments of Labor and Health and...more

Troutman Pepper Locke

Ninth Circuit Upholds Administrator’s Denial of Residential Mental Health Benefits Under ERISA

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In an unpublished memorandum decision, the Ninth Circuit in R.R. v. California Physicians’ Service d/b/a Blue Shield of California, affirmed the insurer and administrator’s denial of benefits for a dependent’s residential...more

Pullman & Comley - Connecticut Health Law

Medicare Telehealth Flexibilities Extended Through December 2027

As a follow-up to our post earlier this week, President Trump has signed into law the Consolidated Appropriations Act, 2026 (CAA). The law extends key COVID-19 era Medicare telehealth flexibilities through December 31, 2027...more

Troutman Pepper Locke

CMS’s 2027 Medicare Advantage Proposal: “Flat” Rates with Tighter Risk Adjustment

Troutman Pepper Locke on

On January 26, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) capitation rates and Medicare Part D payment policies. CMS...more

Arnall Golden Gregory LLP

HHS OIG Advisory Opinion 26-01: Commercial‑Only Cost‑Sharing Waivers for a New Colorectal Screening Test Do Not Trigger AKS or...

Key Takeaways - Coverage and beneficiary class drive the outcome. Because the manufacturer’s colorectal screening test currently has minimal federal program coverage and the waiver is limited to commercially insured patients,...more

Foley Hoag LLP - White Collar Law &...

Congressional Investigations: Year in Preview and What to Expect in 2026

This is the fifth installment in our 2026 Year in Preview series examining important trends in white collar law and investigations in the coming year. We will be posting further installments in the series throughout the next...more

Pullman & Comley - Connecticut Health Law

Medicare Telehealth Rules After January 30, 2026: What Practitioners Need to Know Now

During the COVID-19 public health emergency, the federal government eased some of the restrictions placed on the provision of health care services through telehealth for Medicare beneficiaries. ...more

Groom Law Group, Chartered

DOL Proposes Pharmacy Benefit Manager Fee Disclosure Rule

This is the first of several alerts that Groom Law Group expects to issue regarding the new proposed regulation issued on January 29, 2026 by the U.S. Department of Labor (“DOL”) requiring providers of pharmacy benefit...more

Foley & Lardner LLP

DOL Proposes Sweeping New Disclosure Rules for Pharmacy Benefit Managers

Foley & Lardner LLP on

On January 30, 2026, the Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) published proposed regulations (408(b) rules) that would significantly increase transparency requirements for pharmacy...more

McDermott+

CMS releases 2027 Advance Notice for Medicare Advantage and Part D

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CMS released its CY 2027 Advance Notice for Medicare Advantage (MA) and Part D on January 26, kicking off the annual rate-setting process for MA and Part D plans....more

Morgan Lewis - Shifting Sands Of Labor Law

Navigating Employment Law in the Middle East: ADGM Edition Part 2 — Key Takeaways

Our latest Navigating Employment Law in the Middle East webinar turned the spotlight back on the Abu Dhabi Global Market (ADGM) and the essential legal obligations employers need to understand when operating there....more

Alston & Bird

Bipartisan Funding Deal Reaches Senate Vote as Partial Shutdown Approaches; CMS Releases Final Rule on Medicaid Waiver of Uniform...

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This week, federal agencies prepare for a partial government shutdown as the Senate advances an appropriations agreement that, if passed, will move to the House for consideration, and CMS released a final rule that tightens...more

DLA Piper

Keeping Watch On Medicare: 2026 Maximum Fair Prices For Ten Selected Drugs

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With appreciation for feedback from Mark Fendrick, Director of the Value-Based Insurance Design (V-BID) Center at the University of Michigan; Daneen Sekoni, Vice President of Policy and Advocacy at the Cancer Support...more

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