From new updates to prior authorization models to shifts in the federal No Surprises Act, here are five recent policy developments ASC leaders need to know.
The No Surprises Act
Several physician groups recently praised a final rule aimed at improving the Independent Dispute Resolution process under the No Surprises Act.
The rule, released May 28 by the departments of Health and Human Services, Labor and Treasury, includes changes designed to increase transparency and streamline payment disputes between providers and insurers. Among the reforms are a reduction in administrative fees and new transparency requirements, including the use of standardized claim adjustment and remittance advice codes to help providers determine whether claims are eligible for the IDR process.
The IDR process has become highly controversial in the ASC and physician practice space, with one physician group in Texas projecting that they spent more than more than $51 million in avoidable administrative costs tied to current No Surprises Act arbitration batching rules and unpaid IDR awards.
Antonio Hernandez Conte, MD, the former president of the California Society of Anesthesiologists, told Becker’s that insurers frequently delay the payment timeline within the IDR process.
“The No Surprises Act remains a continual burden for anesthesia practices as insurers delay payments for up to 90 or 120 days even if anesthesia groups are successful in the arbitration dispute resolution process,” he said.
Student loan caps impacting key workforce shortages
The Education Department on April 30 finalized a rule implementing sweeping changes regarding federal student loans. The policy update treats advanced nursing degrees, including those obtained by certified-registered nurse anesthetists, as graduate programs rather than progressional ones. As a result, students in those programs would be placed in the lower borrowing tier, limiting annual federal loans to $20,500 beginning July 1. This aligns with concerns raised by health systems and industry groups when the rule was proposed.
The rule has received significant pushback from an array of industry groups, including the American Association of Nurse Anesthesiology. Most recently, the AANA joined a coalition of nursing organizations in a lawsuit challenging the rule, arguing that it creates financial barriers for nurses pursuing graduate and advanced practice education, despite those programs meeting statutory requirements.
“The AANA is deeply concerned by the Department of Education’s decision to limit federal student loan access for advanced practice nursing degrees,” AANA President Jeff Molter, MSN, CRNA, said in a statement. He said the policy could reduce access to anesthesia services, particularly in rural and underserved communities where CRNAs often serve as the primary anesthesia providers.
A new wave of Medicaid cuts
CMS recently proposed a rule that would place caps on certain state Medicaid payments in an effort to align them more closely with Medicare rates.
The proposed rule would create new limits for Medicaid state-directed payments and certain fee-for-service payments to reduce Medicaid spending by more than $775 billion over 10 years, including $510 billion in federal savings, according to the agency. In a May 20 news release, CMS Administrator Mehmet Oz, MD, said that “Medicaid was never meant to be a blank check — it was meant to be a lifeline — and lifelines only work when they’re strong, reliable and built to last.”
“Misaligned payment incentives and opaque financing arrangements are driving up costs without delivering better care,” he added. “This rule restores balance by aligning Medicaid payments with Medicare standards, strengthening accountability and ensuring taxpayer dollars support patients, not payment schemes. “
The rule specifically targets state-directed payments, which are arrangements in which a state tells a managed care plan how to pay providers, rather than allowing the plan to negotiate rates on its own. CMS said states have used these arrangements to boost payments to a specific set of providers, typically those that can supply the non-federal share of Medicaid funding through provider taxes and intergovernmental transfers. The practice has allowed states to draw more federal dollars without equivalent state spending, according to the agency.
The proposal comes after CMS issued a final rule April 2 that ended states’ ability to use certain provider taxes to generate additional federal Medicaid matching funds, a financing mechanism the agency characterized as a Medicaid funding “loophole.”
The federal fraud crackdown
Federal agencies are escalating their fight against alleged fraud, waste and abuse in Medicare and Medicaid, deploying funding freezes, new enforcement units and criminal prosecutions.
In a May report released by the Office of Inspector General and HHS, the government suspects that physicians may be regularly performing medically unnecessary peripheral vascular procedures in office-based labs. Medicare paid physicians approximately $548 million for performing peripheral vascular procedures in office-based labs in 2023.
The OIG estimates approximately 19%, or $105 million, of these procedures may have been medically unnecessary.
On May 13, CMS imposed a six-month nationwide freeze on new Medicare enrollments for hospices and home health agencies. A separate six-month moratorium on some durable medical equipment, prosthetics and orthotics suppliers had already been established in February.
In April, the Justice Department launched a new West Coast Health Care Fraud Strike Force that has brought charges against more than 6,200 defendants.
New scrutiny of prior authorization
Democratic lawmakers introduced resolutions in the House and Senate to overturn CMS’ Wasteful and Inappropriate Services Reduction (WISeR) model, an AI-assisted prior authorization initiative under traditional Medicare..
CMS launched WISeR at the start of 2026, with plans to run the model through the end of 2031 in Washington, New Jersey, Ohio, Oklahoma, Texas and Arizona. The model applies prior authorization requirements to select traditional Medicare services and relies on for-profit contractors using AI tools to process requests and reviews. Democrats have attempted to block WISeR through multiple legislative avenues since CMS announced the model last June, including appropriations amendments and standalone legislation, without success.
Last year over 60 major health insurers pledged to streamline prior authorization processes — but few physicians think these pledges have made a difference in PA burden, according to the American Medical Association’s “2025 AMA Prior Authorization Physician Survey” released May 13. Recently, UnitedHealthcare reaffirmed this pledge, saying it would pare down PA for 30% of applicable services.
Despite the recent promises and the 2018 “Consensus Statement on Improving the Prior Authorization Process” being released nearly 7 years before this survey, physicians report health plans have made little progress honoring their commitments. Only 16% of physicians working with UHC and 16% working with Cigna say those changes actually reduced the number of PAs they complete.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.