AGG Talks: Home Health & Hospice Podcast - Episode 9: The Impact of AI and Prior Authorizations on Home Health and Hospice
The CMS Interoperability and Prior Authorization Rules
AI adoption in healthcare is no longer limited to large health systems and well-capitalized technology platforms. With 46% of healthcare organizations currently implementing generative AI technologies, the question is no...more
Key Takeaways: The House Appropriations Committee approved a rider June 9 that would block FY 2027 funding for CMS’s WISeR model. Unless the rider becomes law, however, the AI-driven prior authorization program will remain...more
On June 10, 2026, the Ohio General Assembly passed a significantly revised version of Senate Bill 315 (SB 315), originally a bill addressing Supplemental Nutrition Assistance Program (SNAP) card security, which was amended to...more
News Briefs - High Court Won't Hear Drug Manufacturer Price Negotiation Appeal - The Supreme Court declined to hear an appeal from six drug manufacturers that wanted the court to reject the Medicare Drug Price Negotiation...more
The Ohio House Medicaid Committee adopted a substitute bill for House Bill 795, now known as the Ohio Medicaid Program Integrity and Fraud Prevention Act. The substitute bill significantly expands the original version of...more
Artificial intelligence (AI) is rapidly reshaping healthcare, influencing how insurers evaluate risk, providers deliver care and patients experience treatment. Though these technologies promise efficiency, innovation and...more
Healthcare providers, suppliers, compliance leaders, and private equity-backed platforms may prepare for increasing operational, reimbursement, compliance, and governance risks as AI-assisted utilization review expands across...more
Reforming prior authorization processes has been on the regulatory menu for a while. Both patients and providers have argued that prior authorization is a complex and burdensome process that too often results in patients...more
Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Cassidy convened two healthcare hearings in Louisiana in advance of his Senate primary on May 16, 2026. He was the only committee member in attendance....more
News Briefs - CMS, FDA Announce RAPID Pathway for Breakthrough Medical Devices - The Centers for Medicare & Medicaid Services has introduced a new coverage pathway for Medicare beneficiaries to get expedited coverage for...more
UnitedHealthcare (UHC) promises to exempt roughly 1,500 rural hospitals and all critical access hospitals from most prior authorization requirements across all lines of business by the end of 2026. ...more
On April 14, 2026, the Centers for Medicare and Medicaid Services (“CMS”) published a proposed rule that would require faster prior authorization (“PA”) decisions, expand electronic PA to drugs, and increase transparency...more
As artificial intelligence (“AI”) continues to be deployed in new use cases, state legislatures are considering measures to oversee its use in health insurance, particularly in prior authorization and utilization review. Last...more
News Briefs - States Step in to Oversee, Regulate Healthcare - They say that nature abhors a vacuum, and, apparently, U.S. healthcare doesn't care for one much, either. Because in the absence of federal legislation and...more
On April 10, 2026 (and officially published in the Federal Register on April 14, 2026), CMS published a proposed rule that would expand electronic prior authorization requirements, modernize HIPAA transaction standards, and...more
News Briefs - 2025 Hospital Expenses Rose by 7.5%, Workforce Expenses Up 5.6% - U.S. hospitals saw total expenses rise by 7.5 percent in 2025, according to the American Hospital Association's latest annual Costs of Caring...more
In this alert, we summarize key details of the Office of Inspector General’s (OIG) updated Medicare Advantage Compliance Program Guidance (the “Guidance”) for Medicare Advantage Organizations (MAOs), delegated providers, and...more
The University of Miami Herbert Business School’s Business of Healthcare conference on February 6, 2026, brought together payers, providers, clinical leadership, pharmaceutical executives, and federal policymakers. The agenda...more
On Jan. 1, 2026, several significant changes from the Centers for Medicare & Medicaid Services (CMS) took effect for suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). A key change is the...more
The Centers for Medicare & Medicaid Services (CMS) has been using prior authorization for selected Hospital Outpatient Department (OPD) services for several years as part of its broader effort to curb improper payments and...more
On January 14, 2026, Massachusetts Governor Maura Healey announced that the Division of Insurance (DOI) will be promulgating updates to its regulations with the intent of streamlining prior authorization practices for health...more
Explore 2025 managed care enforcement trends under the Trump administration. Learn about Department of Justice (DOJ) and Centers for Medicare & Medicaid Services (CMS) priorities, Medicare Advantage (MA) risk adjustment...more
On January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) launched an unprecedented audit tool called the Wasteful and Inappropriate Service Reduction (WISeR) Model. The WISeR model aims to respond to...more
The Centers for Medicare and Medicaid Services (CMS) is poised to launch a bold, new initiative to reduce waste, fraud and abuse. Starting January 1, 2026, the Wasteful and Inappropriate Service Reduction (WISeR) Model will...more
Medicare Advantage (MA) continues to grow in enrollment, but understanding how coverage decisions are made – and what CMS requires – remains complex....more