CMS Posts New FAQs on CMS-0057-F, Includes Metric Reporting Template. The Centers for Medicare & Medicaid Services (CMS) posted new Frequently Asked Questions (FAQs) on the Prior Authorization application programming interface requirements in the CMS Interoperability and Prior Authorization (CMS-0057-F) final rule. Included in the FAQs is information on the public reporting by impacted payers on their websites of certain prior authorization metrics from the previous calendar year, including a template. The requirement to post the reporting metrics went into effect on January 1, 2026, with a deadline to post the information by March 31, 2026. Reporting of the metrics is to be completed and posted annually. Additional FAQs address accounting for appeals and more than one prior authorization per treatment episode.

Senate Votes to Maintain CMS WISeR Model. The U.S. Senate voted to maintain the CMS Wasteful and Inappropriate Services Reduction (WISeR) Model by rejecting a joint resolution that called to invoke the Congressional Review Act (CRA) and disapprove the model. The action came following the release of a decision by the Government Accountability Office that determined that the WISeR Model Notice is a rule for purposes of the CRA’s submission requirements. A similar joint resolution was introduced in the U.S. House of Representatives, but no action has been taken on it to date.

The WISeR Model began on January 1, 2026, and will run for six performance years through December 31, 2031, in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The intent of the model is to leverage enhanced technologies, such as artificial intelligence (AI) and machine learning, along with human clinical review, to ensure timely and appropriate Medicare payment for select items and services.

Congress Marks Up and Advances Health Care Bills. Committees in the U.S. Senate and House of Representatives advanced bills that would address critical health care issues. In the Senate, the Committee on Health, Education, Labor and Pensions advanced the bipartisan bill S.2355 “Patients Deserve Price Tags Act” introduced by Sen. Roger Marshall (R-KS) that would strengthen price transparency requirements for hospitals, clinical diagnostic laboratories, imaging facilities, ambulatory surgical centers (ASCs), and health plans. The bill will go to the full Senate for further consideration. In the House, the Energy and Commerce Subcommittee on Health advanced the bipartisan bill H.R. 9393 “Lower Costs, More Transparency Act of 2026” introduced by Rep. Brett Guthrie (R-KY) and co-sponsored by Rep. Frank Pallone (D-NJ) that would require hospitals, ASCs, clinical laboratories, imaging facilities, and commercial health plans to comply with specific price transparency requirements. The bill was also referred to the House Ways and Means and Education and Workforce committees.

Additionally, the House Ways and Means Committee marked up the following bills on price transparency, prior authorization, and remote patient monitoring:

• R. 9645, the “Health Care Price Certainty for All Americans Act,” introduced by Jason Smith (R-MO) would promote health care price transparency. The bill was ordered favorably reported to the House of Representatives as amended.
• The bipartisan bill H.R. 3514, the “Improving Seniors’ Timely Access to Care Act of 2025,” introduced by Rep. Mike Kelly (R-PA) would establish requirements on the use of prior authorization under Medicare Advantage plans. Edits were made to the bill during the mark-up and the Amendment in the Nature of a Substitute to H.R. 3514 was passed.
• The bipartisan bill H.R. 3108, “Rural Patient Monitoring Access Act,” introduced by Rep. David Kustoff (R-TN) would condition Medicare payment for remote patient monitoring services on certain requirements, specifically on the ability of clinicians to be available in real time, ability of a system to transmit data in a format compatible with electronic health records, and reporting of data to evaluate any cost savings. Edits were made to the bill during the mark-up and the Amendment in the Nature of a Substitute to H.R. 3108 was passed.

HHS Announces Efforts to Support Genesis Mission. The Department of Health and Human Services (HHS) announced it will undertake support of the Genesis Mission that is designed to employ AI in support of biomedical research and accelerate discoveries to improve health care. HHS will work in partnership with the White House Office of Science and Technology Policy in launching a series of National Science and Technology Challenges calling on the scientific community to apply next-generation AI to critical health care challenges. HHS agencies, including the National Institutes of Health, Food and Drug Administration, and Advanced Research Projects Agency for Health, plan to contribute diverse scientific datasets and encourage researchers to explore how AI can accelerate breakthroughs to improve health care. Specific challenges will focus on pediatric cancer and drug discovery. 

ONC Announces EHIgnite Phase 1 Winners. The Office of the National Coordinator for Health Information Technology (ONC) announced the Phase 1 winners of the ONC EHIgnite Challenge. The goal of the EHIgnite Challenge is to develop solutions using AI to turn large electronic health information (EHI) exports into clearer, more actionable information for patients and providers. The nine teams received a $10,000 award and an invitation to advance to Phase 2. The winners are:

• Avista Development LLC
• CareLead, Inc.
• HealthLink360
• HubChart
• Onni Health Inc.
• MediVu
• Benten Technologies, Inc.
• Precision Health Ventures

• Washington Health Summary

An EHIgnite Challenge Phase 1 Winners Showcase is being held on August 6. In Phase 2, which will conclude in March 2027, the nine teams will be competing for a $400,000 prize pool, including a $250,000 grand prize.

CHAI Launches Initiative to Advance AI at Scale for Public Health Agencies. The Coalition for Health AI (CHAI) launched an initiative, called “Public health Use case and Learning Scaling Engine” (PULSE), aimed at advancing responsible AI at scale for state, tribal, local, and territorial public health agencies. CHAI will select the participating entities and assign individuals to their preferred use-case communities of practice. Participants will then develop playbooks across five key use cases that will serve as best practices for other jurisdictions to use, including: (i) Biosurveillance: Drug Wave Prediction; (ii) Social Determinants of Health: SDoH Mapping: (iii) Operations and Efficiency: Community Feedback Analysis; (iv) Public Communications: Multilingual Translation Hub; and (v) Automated Clinical Data Retrieval: FHIR Query Engine. PULSE's goal is to accelerate the adoption of generative AI in public health by piloting the most impactful use cases in 10 select jurisdictions and then translating learnings into playbooks at a national scale. The call for participant applications is now open and will be accepted through Friday, August 7. 

DataSpring Survey for 2026 Index Closing Soon, Industry Encouraged to Participate. The DataSpring, powered by CAQH, 2026 Index data collection survey tool will close on August 3. The industry is encouraged to participate by contributing data. Past releases of the Index have benefited significantly from medical and dental health plans, providers, and vendors submitting data. Data received through the survey will allow DataSpring to assess the progress of administrative automation and identify potential cost savings. Data contributors receive custom benchmark reports with detailed comparisons between their performance and national results. For information, contact insights@dataspring.com.  

X12 to Hold Second Webinar on HIPAA Version 008060 835 Transaction. The Standards Development Organization X12 will hold a second webinar focused on the 008060 version of the Health Care Claim Payment/Advice implementation guide (835) on July 29 at 2 pm ET. This webinar is part of its 008060 education and information series. X12 will continue to share webinars and additional content to better assist industry stakeholders understand the enhancements in the 008060 versions of standards already mandated under HIPAA. Registration is now open. Additional webinars and on-demand presentations for previous educational sessions will be offered in the future. Questions about the 008060 education and information series can be submitted via the X12 feedback form.