State & Federal Regulations

Medicare's AI-Driven Prior Authorization Pilot Draws Physician Backlash and a Federal Lawsuit

Sonia Reyes
Prior Authorization & Appeals, State & Federal Regulations, Medicare/Medicaid Updates, Healthcare Headlines, Policy & Legislation, Reimbursement Changes, Practice Management, Regulatory & Legislative Updates | Apr 10, 2026
Three months into Medicare's WISeR prior auth pilot, physicians report widespread claim denials, and the EFF has sued CMS for transparency on AI vendor practices.

Grail's Failed Trial: Implications for Managed Care from a Fruitless Blood Test

George Padron
State & Federal Regulations, Medicare/Medicaid Updates | Feb 23, 2026
Grail's Galleri multi-cancer blood test failed to reduce late-stage diagnoses in a 142,000-person NHS trial, complicating Medicare coverage prospects and FDA review.

FDA Reverses Its Decision on Moderna mRNA Flu Vaccine Amid Regulatory Stability Concerns

Sonia Reyes
State & Federal Regulations, Healthcare Headlines | Feb 19, 2026
The FDA agreed to review Moderna's mRNA-1010 flu vaccine after reversing its February refusal, with a PDUFA target date of August 5, 2026, pending post-marketing requirements for adults 65+.

Federal Hemp Crackdown May Cause Coverage, Care Gaps for Managed Care Plans

Sonia Reyes
State & Federal Regulations, Regulatory & Legislative Updates | Feb 12, 2026
A new federal law banning most hemp-derived CBD products by November 2026 signals rising prescription demand and potential ED utilization spikes for managed care organizations to monitor.

AI-Driven Prior Authorization Pilot Launches in Traditional Medicare

George Padron
AI & Critical Decision Support, State & Federal Regulations, Medicare/Medicaid Updates, Policy & Legislation, Reimbursement Changes | Feb 10, 2026
Medicare launches AI-powered prior authorization pilot in six states; critics warn tech vendors have financial incentives to deny care under new WISeR program.