Introduction
As summer approaches, June brings fresh energy and a bright focus on upcoming initiatives. RubinBrown's Healthcare Consulting Group is proud to present this month's issue that highlights key updates, ongoing priorities, and notable developments shaping the months ahead.
Blogs
HIPPA Security Rule Changes: 2025 & 2026 HIPAA Updates
The updated HIPAA Security Rule represents the most sweeping changes since 2013 in response to escalating cybersecurity threats. All safeguards are mandatory, with expanded obligations for business associates and stricter technical, documentation, and incident‑response requirements across the healthcare sector.
Strengthened Transparency in Price and Coverage With Schema 2.0: Requirements for Hospitals and Health Plans
New price transparency rules are now in effect, requiring hospitals and health plans to follow Schema 2.0 standards that improve the accuracy and comparability of pricing data. The changes replace estimates with actual allowed amounts and strengthen regulatory expectations for machine‑readable files.
Important Updates & Deadlines
Cost Reporting Alert: Medicare Advantage Rates Must Align With Price Transparency Data
Starting with cost reporting periods ending on or after January 1, 2026, hospitals will need to align their Medicare Cost Report with their Hospital Price Transparency data; specifically, by accurately reporting Medicare Advantage (MA) negotiated rates.
For IPPS hospitals, this means using the most recent version of their publicly posted machine-readable file (MRF) to calculate the weighted median payer-specific negotiated charge for each MS-DRG, as reported on the new Worksheet S-12 of the Centers for Medicare & Medicaid Services Form 2552-10.
In practical terms, hospitals should be preparing now to:
- Confirm their MRF includes complete and accurate MA negotiated rates, expressed as dollar amounts
- Ensure consistency between price transparency data and cost report inputs
- Develop the ability to calculate discharges by DRG for each MA plan during the reporting period to support weighting
This isn’t just a reporting exercise. Centers for Medicare & Medicaid Services has indicated this data may be used to inform future MS-DRG weight setting, meaning inaccuracies today could directly impact reimbursement down the line.
For additional information:
FY 2026 OPPS Final Rule Section XX. Market-Based Medicare Severity- Diagnosis Related Groups (MS–DRG) Relative Weight Data Collection and Change in Methodology for Calculating MS–DRG Relative Weights Under the Inpatient Prospective Payment System (p. 54013 – 54024)
CMS Update: Real Time Prior Authorization Becomes Mandatory
The CMS-0057-Final Rule (Interoperability and Prior Authorization Final Rule) represents a transformative shift in how prior authorization is managed, targeting the administrative burden that has long slowed care delivery. Affecting Medicare Advantage, Medicaid Managed Care, CHIP, and Qualified Health Plan issuers, the mandate requires payers to transition to real-time, point-of-care prior authorization workflows powered by FHIR-based APIs aligned with Da Vinci implementation guides. With required capabilities such as Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS), and a firm compliance deadline of January 1, 2027, organizations face both a regulatory challenge and an opportunity to modernize. Our consulting team helps clients navigate this complexity—streamlining implementation, optimizing processes, and accelerating readiness to achieve compliance while improving provider and member experiences.
Contact us today to discuss how we can support your organization’s journey to compliance and operational excellence.
Where You’ll Find RubinBrown
We actively support the healthcare community through conferences, events, and educational programming. Below is where we’ve been—and where you can find us next.
Let’s Connect in Person
Our team regularly participates in industry conferences to stay close to evolving challenges and best practices. If you’re attending any of the events below, we’d welcome the opportunity to connect.
Upcoming Webinars: Join Us for Practical, Provider‑Focused Education
Our webinars focus on real‑world challenges and actionable strategies tailored for healthcare providers.
Key Takeaways from Recent Industry Events
Julie Hardy and Tim Jodway attended the NatCon annual conference in April, where several timely themes emerged for behavioral health organizations:
- National Council President and CEO Chuck Ingoglia kicked off the conference by reminding us that the challenges behavioral health providers face are not insurmountable. They require new approaches, new strategies and the belief that things will be better; not just hoping for change but believing in the change our resolve can bring.
- Another highlight was the keynote with Angela Duckworth, PhD, psychologist and bestselling author of “Grit: The Power of Passion and Perseverance.” There’s no question that everyone in the mental health and substance use field embodies these qualities, but Dr. Duckworth shared how to leverage them to show up when it’s hard, to push through adversity and to make our communities better every day.
- There’s a lot of movement with CCBHCs, specifically with additional states exploring expansion programs, and SAMHSA supporting additional credentialing bodies. While some states require certification for these organizations, many don’t, and it’s important for providers to know what will be expected of them, especially those who have locations in multiple states.
- While behavioral health organizations historically have been slow to adapt to value based contracts, it’s clear that this is changing quickly. There were several breakout sessions where different elements of value based contracting was discussed, and providers are encouraged to start working with their states sooner rather than later to take advantage of what this type of contract could mean for them.
Reach out to
Julie or
Tim to learn more about these and other reimbursement and revenue cycle insights in the behavioral health space.
Recent Webinars
Missed a Session? Here’s What You Need to Know
• Certified Community Behavioral Health Clinics (CCBHC): An Evolution of Behavioral Health Treatment and Payment. This session covered CCBHC certification requirements, core services, PPS reimbursement mechanics, and strategic considerations shaping sustainable behavioral health care delivery.
• Cyber Security Simplified: Affordable Steps to Strengthen Rural Health Provider Systems. Attendees gained a practical, budget‑conscious roadmap to reduce cyber risk, prioritize safeguards, and protect patient care without adding staff or significant cost.
If you were unable to attend any of our webinars but would like additional information, please contact Claudine Hildreth at
Claudine.Hildreth@RubinBrown.Com / 810.853.6182
Published: 06/22/2026
Readers should not act upon information presented without individual professional consultation.
Any federal tax advice contained in this communication (including any attachments): (i) is intended for your use only; (ii) is based on the accuracy and completeness of the facts you have provided us; and (iii) may not be relied upon to avoid penalties.