It's Wednesday, and today's brief is heavy on policy news. Legislation to reform the prior authorization process in Medicare Advantage plans has bipartisan support in Congress, but it's not clear if a bill will pass this year. Meanwhile, a government shutdown is possible over disagreement about Medicare, Medicaid and Affordable Care Act funding. Read more in the Lead Story and Deep Dive.

What we're also covering: 

• Finding value in value-based care
• CMS details $50B rural health program

Efforts to reform the prior authorization process in Medicare Advantage plans remain stalled in Congress despite bipartisan support for the Improving Seniors' Timely Access to Care Act. The bill would establish a process for electronic prior authorization, set standards for attachments and increase transparency. The CMS has introduced regulations to streamline prior authorization, effective January 2026, but the agency is also launching a prior authorization pilot program for conventional Medicare.

What's happening: Hospitals are urging Congress to extend telehealth approvals and other health programs set to expire Sept. 30. The American Hospital Association has highlighted the importance of telehealth and the Medicaid Disproportionate Share Hospital program, which faces an $8 billion cut. Hospitals also are seeking to preserve Medicare programs that support rural hospitals and enhanced tax credits under the Affordable Care Act.

Ripple effect: Millions of Americans stand to lose health insurance coverage if Medicaid cuts are enacted and ACA tax credits aren't extended. Financial pressure would mount on hospitals, which would have to provide uncompensated care for those who can't afford to pay their medical bills.

Shutdown looming? Democratic leaders are warning of a potential government shutdown at the end of this month if their concerns about rising health insurance premiums are not addressed in a stopgap funding measure. The bill needs bipartisan support to pass the Senate. "What the Republicans have proposed is not good enough to meet the needs of the American people and not good enough to get our votes," said Senate Minority Leader Chuck Schumer, D-N.Y.

Republicans in the House have unveiled legislation to extend government funding through Nov. 21, excluding provisions addressing health care costs that had been sought by Democrats. The legislation could get a vote in the House by Friday, Senate Majority Leader John Thune has suggested that he would prefer that the upper chamber also consider the bill this week.

Muskingum Valley Health Center in Ohio has developed a value-based care department led by 19 nurses and is participating in the ACO REACH model. The community health center has reduced its medical loss ratio from 104% to 85% and is now projecting a surplus. The Medical Home Network provides MVHC with strategic guidance in practice transformation and risk stratification. "This partnership has allowed us to springboard our entire program to the next level," says Dan Atkinson, MVHC CEO.

The CMS has opened the application window for the $50 billion Rural Health Transformation Program, aimed at improving rural health care infrastructure and access. States have until Nov. 5 to apply for the funding, which will be distributed over five years beginning in fiscal 2026. The CMS will prioritize projects featuring new technologies, strategic partnerships and financial stability, with a focus on improving access, outcomes and workforce recruitment.

Oracle has introduced artificial intelligence tools to make patient portals more user-friendly and interactive as part of a broader effort to transform clunky, underused platforms into effective tools for patient engagement. AI tools may also transform EHR systems into more than billing platforms and make portals more responsive to patient and clinician needs. On the payer side, Optum CEO Patrick Conway says AI agents will be able to handle calls and provide benefit reviews immediately.