Tennessee lawmakers recently passed a bill banning PBMs from owning pharmacies in the state, though like a similar Arkansas law, it is expected to face legal challenges if enacted.

The post Will Tennessee’s PBM Bill Face the Same Fate as Arkansas’ Law? appeared first on MedCity News.

Despite genuine efforts across the industry to reduce protocol complexity, the trend line hasn’t budged. The reasons are partly scientific and operational. And they’re also deeply human.

The post Why Protocol Complexity Keeps Increasing – and How to Fix It appeared first on MedCity News.

The first major update to HIPAA in more than a decade will eliminate the distinction between “required” and “addressable” safeguards, making key cybersecurity and physical security measures mandatory for all healthcare providers. This shift will expose gaps in hospitals’ fragmented security systems, though, according to Kumar Sokka, CEO of cybersecurity platform Acre Security.

The post Why Some Hospitals Won’t Be Able to Comply With Upcoming HIPAA Updates appeared first on MedCity News.

Financial assistance is moving from discretionary policy to regulated infrastructure. For health systems, that shift has significant operational and financial implications.

The post Financial Assistance Reform Is Reshaping Revenue Cycle Strategy appeared first on MedCity News.

Lawmakers introduced the Medicare Advantage Improvement Act of 2026 to tighten prior authorization rules, boost transparency and curb practices that delay care.

The post Bipartisan Bill Seeks to Strengthen Oversight of Medicare Advantage appeared first on MedCity News.

The American Medical Association is urging Congress to add safeguards for AI mental health chatbots amid safety concerns, while noting their potential to expand access.

The post AMA Calls on Congress to Improve Safeguards for AI Mental Health Chatbots appeared first on MedCity News.

While other areas of healthcare have been star-struck by sophisticated AI and massive infrastructure investments, safety net entities have found that the answer is much simpler. Better managing chronic conditions across populations simply requires the right connection at the right time. 

The post The Quiet Revolution Comes Full Circle: How CMS ACCESS Validates Safety-Net Innovation appeared first on MedCity News.

At the Medicarians Conference, Ricardo Carcas, assistant special agent in charge of the Office of Investigations, discussed cases of fraud in the ACA and how the DOJ is combatting it.

The post How the DOJ Is Tackling Fraud in the ACA Marketplace appeared first on MedCity News.

A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny.

The post Policy Expert Believes CMS is Taking “Adversial Posture” to Medicare Advantage appeared first on MedCity News.

OSHA and NIOSH recommend that all hospitals develop comprehensive violence prevention programs. Here are some action items that provide a framework for building a legally defensible program.

The post OSHA’s Evolving Approach to Workplace Violence Prevention in Healthcare appeared first on MedCity News.

The future of social security depends on the strength of our collaboration and our unwavering commitment to the people we serve. The challenges are significant, but so are the opportunities for innovation.

The post Strengthening Social Security in a Changing World appeared first on MedCity News.

Rep. Greg Murphy introduced a bill that would require out-of-pocket prescription drug spending to count toward patients’ deductibles and out-of-pocket maximums regardless of where the drugs are purchased.

The post New Bill Seeks to Lower Out-of-Pocket Drug Costs appeared first on MedCity News.

President Donald Trump’s 2027 budget proposes deep healthcare cuts, raising concerns about harm to patients and research.

The post ‘A Significant Assault on Our Health’: Healthcare Policy Leaders Condemn Trump’s Budget Proposal appeared first on MedCity News.

Consumers are inundated with false information circulating online about GLP-1 medicines, which causes confusion and can lead to potentially serious health problems resulting from dosing errors and adverse reactions to ingredients in compounded GLP-1 products.

The post It’s Time to Put Guardrails on GLP-1 Compounding appeared first on MedCity News.

Over the past 15 years, financial and administrative barriers – most notably step therapy mandates and prior authorization requirements – have repeatedly forced patients through suboptimal or ineffective treatments before they can try another therapy, have tied the hands of healthcare professionals and patients alike. Now there’s a possible solution.

The post Join the Fight Against Chronic Pain: It’s Time for Breakthrough Legislation in Congress appeared first on MedCity News.

An algorithm can flag an irregular heartbeat. But it cannot notice that Tom hasn’t mentioned his late wife in two weeks, or that he’s wearing the same shirt for the fourth day running. Those observations require a person in the room, not a sensor on the wall.

The post The Algorithm Won’t Hold Your Mother’s Hand appeared first on MedCity News.

A group of 131 hospitals has sued HHS over a CMS policy they say improperly reduces Medicare disproportionate share hospital (DSH) payments. The lawsuit is the latest in a decade-long legal battle over how the agency counts patient days and calculates payments for safety net hospitals.

The post Why 131 Hospitals Are Suing HHS Over Alleged Underpayment appeared first on MedCity News.

In the latest episode of the Debunked podcast, MedCity News Editor-in-Chief Arundhati Parmar and Samir Batra, Managing Partner of Health Innovation Pitch, discussed recent M&A deals and how bots can be manipulated.

The post Debunked Episode 25: Sutter Health’s Allina Health Acquisition Strategy, a Deep Dive on Doctronic appeared first on MedCity News.

Sixty million rural Americans aren’t asking for another strategic framework. They’re asking for care — accessible, affordable, and delivered with dignity.

The post Rural America Doesn’t Need Another Framework … It Needs Care by September 2026 appeared first on MedCity News.

March has seen a slew of executive hires, exits and layoffs across the healthcare industry. For instance, Flare Capital Partners, SCAN Group and Advocate Health named new executives. There were also layoffs at organizations including Oracle, Takeda and Blue Shield of California.

The post Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs appeared first on MedCity News.

For consumers and clinicians the difference between “FDA-cleared,” “FDA-registered,” and general wellness products is not always obvious. Clear communication about intended use and supporting evidence is essential for maintaining trust.

The post Red Light Therapy’s Regulatory Implications appeared first on MedCity News.

Providers that embrace benchmarks from outside of healthcare and move toward improved non-clinical spend management will unlock the resilience, innovation, and possibilities needed to stay strong in the years ahead.

The post The Cost Blind Spot: Why Non-Clinical Spend Is Healthcare’s Untapped Opportunity appeared first on MedCity News.

Industry leaders say the No Surprises Act is protecting patients from surprise bills, but its Independent Dispute Resolution system is being overused and exploited, driving up costs and prompting calls for reform.

The post ‘This is Crazy’: Health Experts Call for Changes to the No Surprises Act appeared first on MedCity News.

Experts are split on whether H.R. 1 Medicaid changes in 2027 will roll out gradually or on schedule.

The post Could There Be a ‘Soft Opening’ of H.R. 1 Medicaid Changes? appeared first on MedCity News.

Rising healthcare costs are a key focus for AHIP, whose CEO says the group is pushing reforms to boost competition and reduce administrative burden.

The post AHIP CEO: “We Are Laser-Focused on Affordability” appeared first on MedCity News.

The specialty access and capacity crisis demands more than incremental fixes. It requires expanding virtual access and fundamentally rethinking how specialty care can be delivered.

The post Virtual Specialty Care Has Time. Will We Use It Wisely? appeared first on MedCity News.

In a recent letter, Senate Democrats proposed lowering healthcare costs, expanding coverage and cracking down on insurance company practices.

The post 12 Senate Democrats Unveil Plan to Cut Costs, Expand Coverage appeared first on MedCity News.

An NYU Stern report links private equity in healthcare to worse outcomes and higher bankruptcy risk, calling for reforms and stronger oversight.

The post NYU Stern Report Urges Regulation of Private Equity in Healthcare appeared first on MedCity News.

Leaders must resist the urge to replicate urban models that do not translate well to rural contexts. Instead, they should design solutions that are built for rural communities, grounded in local insight and enabled by scalable capabilities.

The post A Once in a Generation Opportunity to Reimagine Rural Health appeared first on MedCity News.

If CMS and private payers are serious about whole-person health, reimbursement structures must align with the workforce actually delivering that care. Payment pathways should recognize the value of the broader care team and enable the seamless integration of their expertise with the objective data generated through connected devices and programs like RPM.

The post Behavior Changes Happen Outside the Exam Room, But Validation of Lifestyle Medicine Programs Cannot appeared first on MedCity News.