(April 17, 2026) – MLN Connects Provider eNews from the Medicare Learning Network
The Centers for Medicare & Medicaid Services issued the following updates in the MLN Connects Provider eNews:
AbbVie Sues to Restrict 340B Definition of Patient
AbbVie filed a lawsuit against the U.S. Department of Health and Human Services and the Health Resources and Services Administration to challenge HRSA's definition of a "patient" under the 340B Drug Pricing Program. The company contends that HRSA's interpretation allows covered entities to obtain drug discounts for individuals receiving minimal, outdated or loosely connected care at the facility, creating a risk of duplicate discounts and diversion. AbbVie seeks a declaration from the U.S. District Court for the District of Columbia that its more narrowly tailored definition of "patient" should govern manufacturers' audits of covered entities.
CMS Releases Rural Health Transformation Program Frequently Asked Questions
The Centers for Medicare & Medicaid Services released a list of frequently asked questions for the Rural Health Transformation Program to address post-award issues, including the RHTP budget, state actions, reporting and oversight obligations, provider recruitment or retention and sub-awardee/contractor engagement and management.
CMS Releases Proposed Medicare Inpatient and Long-term Care Hospital PPS Payment and Policy Updates for FFY 2027
The Centers for Medicare & Medicaid Services released the proposed federal fiscal year 2027 Medicare payment and policy update for the Hospital Inpatient and Long-Term Care Hospital Prospective Payment Systems. Although CMS published that comments are due no later than 4:00 p.m. on April 10, comments will be due 60 days after publication in the Federal Register.
CMS Releases Proposed Rule to Establish Deadlines for Payers to Issue Prior Authorization for Drugs
The Centers for Medicare & Medicaid Services released a proposed rule to "slash long waiting periods for drugs." The Interoperability Standards and Prior Authorization for Drugs proposed rule would set clear deadlines for payers to issue prior authorization decisions for drugs. Payers would be required to issue decisions within 24 hours for urgent requests and within 72 hours for standard requests. The rule would also increase transparency by requiring full disclosure of claims denials and appeals outcomes.
In addition, CMS is seeking comments on ways to streamline the step-therapy process using technology and data sharing, such as the Payer-to-Payer API. Comments are due 60 days after the date of publication in the Federal Register.