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Friday, August 28 · 11 stories
- Federal Policy
Education Department Dismantling Threatens School Services for Autistic Children
The Trump administration's plans to dismantle the Department of Education and reduce civil rights oversight could significantly impact autistic children's access to diagnosis, special education services, and discrimination protections. Researchers and disability advocates warn that eliminating federal education infrastructure risks widening existing disparities in how autistic students receive individualized education programs (IEPs) and accommodations under the Individuals with Disabilities Education Act (IDEA). The cuts to civil rights enforcement mechanisms may weaken oversight of states' compliance with disability protections. These changes affect an estimated 750,000 autistic students nationwide who rely on federally mandated educational supports.
- Legal
McDermott Compliance Clinic Examines Chronic Care Management Billing Risks
McDermott Will & Emery published a compliance analysis examining chronic care management (CCM) services billing, coding, audit exposure, and enforcement risk across Medicare and Medicaid programs. The analysis addresses how providers can structure CCM programs to minimize compliance risk during government audits and investigations. It covers documentation requirements, time-tracking protocols, and common billing errors that trigger OIG scrutiny. The guidance is relevant for Medicaid managed care plans and providers offering CCM services under capitated or fee-for-service arrangements.
- Industry
Trump-Kennedy Health Industry Agreements Lack Enforcement Mechanisms, Face Implementation Uncertainty
Voluntary agreements between the Trump administration and health industry stakeholders on drug pricing, synthetic food dyes, and prior authorization have not been enforced since their announcement. The agreements were publicly touted as policy victories but contain no binding compliance mechanisms or regulatory authority. Implementation timelines remain unclear, and the voluntary nature of the commitments raises questions about whether the agreements will produce measurable changes to industry practices. The lack of enforcement structure leaves managed care organizations and other affected entities without clear compliance obligations or operational guidance.
- Legal
CMS and OIG Prioritize Wound Care Fraud Enforcement in 2026
The Centers for Medicare and Medicaid Services and the HHS Office of Inspector General have made wound care fraud enforcement a priority in 2026. Healthcare providers offering wound care services face increased audit and investigation risk. Non-compliance can result in substantial penalties, including potential Medicare or Medicaid exclusion. Providers should review their wound care billing practices, documentation standards, and compliance programs to mitigate enforcement exposure.
- Federal Policy
CMS Releases 340B Part D Claims Repository Guidance Ahead of October Launch
CMS issued a fact sheet and FAQs on the 340B Part D claims data repository launching October 1, 2026. Data submissions will be voluntary for 340B hospitals initially, but CMS has proposed making them mandatory beginning in 2027. The guidance provides operational details on repository structure, submission requirements, and timelines. The repository aims to improve transparency around 340B drug claims in Medicare Part D, affecting hospitals participating in the 340B program and their Part D relationships.
- Legal
23 States Sue Trump Administration Over Family Planning Grant Requirements
A coalition of 23 states filed suit in Maryland federal court Thursday challenging new conditions on family planning grants that would allegedly require states and providers to align with administration political priorities or lose federal funding. The lawsuit contests restrictions that could affect Title X family planning program funding, which supports reproductive health services including contraception and preventive care for Medicaid beneficiaries. The litigation seeks to block implementation of the new grant requirements. The outcome will determine whether states retain existing federal family planning funding or must choose between compliance with new federal conditions and maintaining current service delivery models.
- Legal · FL
Florida Judge Allows Pediatric Associates Challenge to Medicaid ABA Rates
An administrative law judge ruled that Pediatric Associates has standing to challenge Florida's Medicaid reimbursement rates for applied behavioral analysis (ABA) services for children with autism. Division of Administrative Hearings Judge W. David Watkins denied the state's motion to dismiss the case on Wednesday. The provider alleges the DeSantis administration miscalculated rates that fail to cover ABA service costs. The ruling allows the rate challenge to proceed to a full hearing on the merits.
Thursday, August 27 · 16 stories
- Legal
Humana-Owned Villages Health Settles Medicare Advantage Upcoding Case for $542M
The Villages Health, acquired by Humana in 2025, agreed to pay $542 million to settle allegations it submitted fabricated diagnosis codes to inflate Medicare Advantage risk-adjusted payments from 2020 to 2024. The Department of Justice alleged the Central Florida provider systematically manufactured diagnoses to increase capitation rates. The settlement represents one of the largest Medicare Advantage fraud recoveries to date and follows heightened federal scrutiny of MA risk adjustment practices.
- State Policy
States Diverge on AI Mental Health Tool Regulation Amid Safety Concerns
States are implementing varied regulatory frameworks for AI-driven mental health tools in response to concerns about accuracy and patient safety. Some states are enacting laws that prohibit AI chatbots from advertising or providing therapy services, while others focus on data protection standards, disclosure requirements, and patient consent protocols. The fragmented state approaches reflect ongoing uncertainty about how to oversee digital behavioral health tools. These emerging regulations affect Medicaid-funded behavioral health services, particularly as states and health plans increasingly incorporate digital tools into coverage and care coordination strategies.
- Federal Policy
LGBTQ+ Adults Report Higher Health Care Cost Burdens and Access Barriers Than Non-LGBTQ+ Adults
A new report finds LGBTQ+ adults face significantly greater challenges affording and accessing health care compared to non-LGBTQ+ adults. The analysis documents disparities in cost-related barriers to care, provider access, and insurance coverage adequacy across LGBTQ+ populations. These findings inform Medicaid coverage and access policies affecting LGBTQ+ beneficiaries, particularly in managed care network adequacy standards, benefit design, and culturally competent care requirements. States with large LGBTQ+ Medicaid populations may use these data to evaluate whether current MCO contracts adequately address documented access disparities.
- Federal Policy · GA
CMS Awards Georgia $93.3M for Rural Telehealth and AHEAD Model Readiness
CMS announced $93.3 million in federal Rural Health Transformation Program funding to Georgia on August 27, 2026, supporting 87 rural hospitals in expanding telehealth services, surgical robotics, and modernizing healthcare access. The funding is designed to help these hospitals prepare for CMS' AHEAD Model, a value-based care initiative. The investment targets rural healthcare infrastructure improvements with a focus on technology adoption and alternative payment model readiness. Medicaid managed care plans operating in Georgia's rural markets may see network capacity changes as hospitals enhance capabilities and potentially shift toward value-based arrangements.
- Legal · FL
Florida Grand Jury Finds $10M from Centene Medicaid Settlement Misappropriated
A Florida state grand jury determined that $10 million from a Centene Medicaid settlement was misappropriated under the DeSantis administration, according to a sealed January 28 document obtained by CBS News Miami. The grand jury found insufficient evidence to bring criminal charges. The settlement originated from claims against Centene related to its Florida Medicaid managed care operations. The finding raises questions about state oversight of Medicaid settlement funds and their designated use.
- Legal
ABA Therapy Faces Growing Federal and State Fraud Enforcement Scrutiny
Applied behavior analysis therapy for autism has become a major Medicaid enforcement target as the service category expands rapidly. Federal and state regulators are increasing scrutiny of ABA providers for potential fraud, waste, and abuse violations. ABA providers face heightened compliance risk due to the service's growth trajectory, billing complexity, and evolving coverage policies. The enforcement environment creates significant operational and legal exposure for providers, managed care organizations overseeing ABA networks, and state Medicaid agencies administering these benefits.
- Industry
No Surprises Act Dispute Resolution Costs Reach $22B, Georgetown Finds
New Georgetown University research found that independent dispute resolution under the No Surprises Act has generated $22 billion in additional healthcare costs, driven by accelerating dispute volumes and high arbitration award amounts. The researchers warn that these costs could translate into higher health insurance premiums for consumers. The No Surprises Act, which took effect in 2022, established a federal arbitration process for out-of-network billing disputes but does not apply to Medicaid managed care plans, which operate under different surprise billing protections.
- Federal Policy
KFF Data Note Compiles Current Medicaid Coverage Statistics for Women
KFF has published a data note compiling key statistics on Medicaid coverage for women. The note presents enrollment figures, eligibility pathways, and coverage patterns for women in the Medicaid program. It provides baseline data on how women access and utilize Medicaid coverage across states. The compilation serves as a reference for policymakers and stakeholders tracking women's coverage under Medicaid.
- Industry
Sword Health Acquires Headspace in All-Cash Deal Expected to Close Next Month
Sword Health is acquiring Headspace in an all-cash transaction expected to close in September 2026, according to a filing with Massachusetts regulators. The deal will combine Headspace's wellness services with Sword's virtual care platform under one entity. The acquisition represents consolidation in the digital health space, bringing together musculoskeletal care and mental health/wellness capabilities. Financial terms were not disclosed in the regulatory filing.
- State Policy · LA
Louisiana Allocates 20% of Opioid Settlement Funds to Law Enforcement Equipment
An investigation found Louisiana directed millions in opioid settlement dollars to sheriff departments for law enforcement equipment and police technology rather than addiction treatment services. The state allocated 20% of its settlement proceeds to law enforcement agencies. Settlement agreements intended these funds to abate the opioid crisis through treatment, prevention, and recovery services. The spending raises questions about state compliance with settlement terms and appropriate use of funds designated for public health interventions.
- Federal Policy
Advocates Push for Public Reporting Requirements in $50B Rural Health Transformation Program
Advocacy groups are calling for greater transparency in the Rural Health Transformation Program, a $50 billion federal initiative. States currently must submit progress reports to the federal government but are not required to make those reports or related program information publicly available. The lack of public disclosure requirements limits stakeholder ability to track how states are deploying rural health funding and assess program effectiveness. The criticism highlights broader accountability concerns in large-scale federal health initiatives that flow through state governments.
- Industry
Becker's Compiles Trump Administration Health Technology Policy Actions
Becker's Hospital Review has compiled a tracker of recent Trump administration actions affecting health technology policy, including moves related to AI adoption, digital infrastructure, data sharing rules, cybersecurity requirements, and federal oversight mechanisms. The compilation covers regulatory changes and policy shifts reported by Becker's across multiple areas of healthcare technology. The tracker appears to be an ongoing compilation rather than reporting a single discrete policy event, aggregating developments that may affect hospitals, health systems, and other healthcare entities operating digital health programs.
- State Policy · OH
Ohio Democrats Say Federal Bill Cut SNAP Benefits for 100,000 Residents Including 50,000 Children
Democratic Ohio lawmakers are criticizing the Republican "One Big Beautiful Bill Act" for cutting SNAP benefits to more than 100,000 Ohioans, including over 50,000 children, since President Trump signed the legislation. The lawmakers say the federal law has increased costs for everyday life and reduced access to healthcare and food security. The timing of the cuts and their broader Medicaid implications remain unclear from the article. The story matters for state Medicaid agencies and health plans because SNAP and Medicaid eligibility are often linked, and large-scale federal benefit cuts typically affect overlapping populations that rely on both programs.
