Billy Wynne

CY 2025 MA and Part D Advance Notice Proposes to Increase Payments to Plans by 3.7 Percent; Proposes Implements Final Components of Part D Redesign The Centers for Medicare and Medicaid Services (CMS) announced the Advance Notice of Methodological Changes for Contract Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and…

Department Announces Actions to Address Syphilis Epidemic Amid an 80 Percent Increase in Cases Since 2018 The Department of Health and Human Services (HHS) announced a series of actions to address the surging syphilis epidemic, reaching its highest levels since the 1950s. With 207,255 reported cases in 2022, an 80 percent increase since 2018, and over 3,700 cases…

CMS Releases FAQ Regarding 12-Month Postpartum Medicaid Coverage  On Monday, CMS released an FAQs regarding the implementation of 12-month postpartum Medicaid coverage.  The document includes details regarding what constitutes full benefits during the 12-month extended postpartum eligibility period, defines enhanced pregnancy-related services, outlines the mandatory tobacco cessation benefit for pregnant persons, and clarifies when a…

Cell and Gene Therapy Model with Sickle Cell Disease Focus Announced; LOIs Due by April The Center for Medicare and Medicaid Innovation (CMMI) officially announced the Cell and Gene Therapy (CGT) Access Model, with sickle cell disease as the initial focus of the model (fact sheet, FAQs) The model is pursuant to President Biden’s executive…

CMS Announces Growth in ACO Initiatives The Centers for Medicare & Medicaid Services (CMS) announced participation data for accountable care organization (ACO) initiatives in 2024. CMS reports that about 13.7 million people with Traditional Medicare are aligned to an ACO in 2024, which is a three percent increase since 2023 and represents nearly half of Traditional Medicare beneficiaries.…

Commission Panel Discusses How States are Sustaining and Evaluating New or Enhanced American Rescue Plan HCBS Investments The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a panel focused on policies and activities related to the public health emergency, particularly highlighting a crucial provision in the American Rescue Plan Act (ARPA) that provided states with additional…

Commissioners Discuss Findings from Interviews with Stakeholders on State Medicaid Agency Contracts to Inform Future Policy Options The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to discuss key themes derived from interviews with key stakeholders regarding state Medicaid agency contracts (SMACs). The Commissioner’s discussion will inform future policy options to be presented at the…

Commission Explores Policy Options to Enhance the Transparency of Medicaid Financing; Will Vote on Options at April Meeting The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to examine policy options for improving the transparency of Medicaid financing. Principal Analyst Rob Nelb explained how  the Medicaid statute allows states to fund the non-federal portion of…

Commission Approves Recommendations to Improve Managed Care Appeals Process For March 2024 Report to Congress The Medicaid and CHIP Payment and Access Commission (MACPAC) met to vote on updated recommendations to improve the managed care appeals process to be included in the March 2024 report to Congress. All of the recommendations were approved, but some commissioners…

Commissioners Discuss Areas For Future Work to Better Understand How Medicaid Payment Impacts Access The Medicaid and CHIP Payment and Access Commission (MACPAC) held a discussion about the findings from an expert roundtable on the effect of Medicaid payment changes on beneficiary access to physician services. The themes of this discussion will inform future MACPAC research. Background. Staff…