Hello Readers!
As the season heats up, we’re excited to share updates on evolving health policy, from prior authorization reforms and new Exchange rules for 2027, plans to broader care delivery shifts highlighted during EMS Week 2026, and finally insights into leading models in postpartum care.
We also invite you to join Public Consulting Group (PCG) Fee-For-Service (FFS) subject matter experts for an informative webinar designed for state Medicaid agencies, healthcare providers, and stakeholders to explore the recent CMS proposed rule (CMS-2449-P) and key areas for public comment. More details and registration information can be found below.
As always, HPN will bring you a mid-summer edition and then resume our monthly coverage in the fall. Stay tuned for more insights and enjoy the summer!
Prior Authorization in 2026
Prior authorization is a healthcare utilization management tool that requires providers to request and receive approval for a prescribed drug or service before coverage is provided. The goal of prior authorization is to control costs and promote appropriate care, though concerns remain about potential delays and administrative burden. The Centers for Medicare and Medicaid Services, states, and carriers have been taking action to address concerns raised by the process. To read the full article, Click Here.
HHS Finalizes Annual Exchange Rules
Earlier this month, the Department of Health and Human Services (HHS) finalized the Notice of Benefit and Payment Parameters for 2027 (NBPP), outlining updated Exchange regulations and Qualified Health Plan (QHP) certification standards. As carriers prepare filings and states begin certification reviews, the final rule introduces a range of policy updates. The rule, which takes effect July 20, 2026, includes changes impacting upcoming plan years and reflects ongoing updates to Exchange operations. To read more about the key changes and what they mean, Click Here.
What EMS Week 2026 Reminds Us About the Work Behind Every Call
EMS Week 2026 goes beyond recognition to highlight what is shaping the future of emergency medical services. As care delivery evolves and expectations shift, key themes around coordination, workforce support, and community engagement continue to emerge across the profession. To read more, Click Here.
Supporting Massachusetts Families from the Start
Interest is increasingly shifting from whether universal postpartum home visiting is feasible to how it can be effectively scaled. Massachusetts is leading the way with Welcome Family, a statewide initiative offering every new family a voluntary nurse home visit to provide early support and connections to care. As the program expands, it offers important lessons for strengthening maternal and infant health nationwide. To read more, Click Here.
Webinar Announcement
Key Opportunities for Public Comment: Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments Proposed Rule (CMS-2449-P)
Join Public Consulting Groups FSS subject matter experts for an informative webinar designed for state Medicaid agencies, healthcare providers, and stakeholders to explore the recent CMS proposed rule (CMS-2449-P) and key areas for public comment. This session will focus on the highest-impact provisions and opportunities for stakeholder input, including:
- New payment limits & scope: Medicare-based caps, targeted payments, FFS limits, provider/practitioner subsets, EMS
- Implications & impacts: Managed care SDPs and FFS, phase-out of uniform increases, state and provider changes
- CMS input & design: payment design, value-based treatment, definitions, timelines, exceptions
DATE: Thursday, June 11th 2026 TIME: 2:00 PM – 3:00pm EST
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