Aug. 13, 2025
| This week’s payer news for healthcare leaders
The CMS plans to trial prior authorization requirements in traditional Medicare. A group of Democrat representatives think that’s a bad idea based on the tool’s track record in Medicare Advantage.
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Deep Dive
Thursday’s settlement is weaker than at least one antitrust expert expected based on the severity of the DOJ’s concerns. But it means the $3.3 billion merger is very likely to close next year.
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New limits to the program could force hospitals to slash capital spending while bracing for millions of newly uninsured patients.
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As consolidation transforms healthcare, tensions between insurers & providers intensify over reimbursement rates and care access policies. Examine the complex dynamics of these critical industry relationships in
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UPDATED
The settlement filed with the Maryland district court on Thursday requires UnitedHealth and Amedisys to divest 164 home health and hospice sites to placate the DOJ’s concerns that the merger is anticompetitive.
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Sens. Ron Wyden and Elizabeth Warren are seeking more information from the beleaguered healthcare behemoth after The Guardian found it was incentivizing nursing homes to reduce hospital transfers.
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The KFF’s projection is steeper than an older analysis that relied on less complete data. It’s the largest increase that ACA insurers have asked for in more than five years as payers brace for membership turmoil.
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