Short, plain-language summaries of Medicare, Medicaid and commercial payer changes that can affect licensing, credentialing, enrollment and billing. Each item links to the official or original source. Last updated October 2026.
General information only. This is not legal, billing or compliance advice. Rules change and differ by state and payer, so confirm details with the official source or a qualified professional.
Congress extended the Medicare telehealth flexibilities through the end of 2027. That keeps home-based telehealth reimbursement and the geographic waivers in place for covered services.
What to do: keep telehealth billing set up, and check the current rules for your specific service and specialty before relying on them, since some services have their own conditions.
CMS proposed 2027 conversion factors about 1.2% lower for qualifying APM participants and about 1.7% lower for other providers, because a temporary 2026 increase expires. The proposal also raises payment for behavioral health collaborative care management and tightens rules for remote patient and therapeutic monitoring. It is a proposed rule, so the numbers can change in the final version.
What to do: review your Medicare revenue assumptions for 2027, and watch for the final rule.
A CMS rule sets how states must verify work or community engagement for many adults aged 19 to 64 in the Medicaid expansion group, at application and renewal. People who do not show compliance or an exemption within 30 days can be denied or disenrolled. States decide some details, including optional hardship exceptions.
What to do: expect some Medicaid patients to lose coverage or need help at renewal. Check eligibility before visits, and ask your state Medicaid agency for its plan.
New York updated its Medicaid revalidation schedule. All enrolled Medicaid providers are expected to complete revalidation within the next two years, through the state Provider Services Portal.
What to do: if you bill New York Medicaid, check your revalidation date on the state revalidation page and plan the work early.
CAQH rebranded as DataSpring on June 8, 2026. The CAQH Provider Data Portal keeps its name, your logins and profiles carry over, and attestation is still needed at least every 120 days. Be careful with emails about the change: a real reminder will not ask for your password.
What to do: confirm your next attestation date, check that your license and malpractice documents are current, and log in directly at proview.caqh.org rather than through email links.
UnitedHealthcare says that from October 1, 2026 it is removing about 30% of its prior authorization requirements for most plans. Its notice does not say which plans or services are covered, so check the specific list.
What to do: before sending patients through prior authorization, check the current UnitedHealthcare requirement for each service, since some may no longer need it.
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