Billy Wynne

Commissioners Discuss the Use of AI for Medicaid Prior Authorization The Medicaid and CHIP Payment and Access Commission (MACPAC) held a meeting to discuss automation and artificial intelligence (AI) in the prior authorization (PA) process. Commissioners were excited about the potential of AI to streamline PA but have concerns about bias and denials without proper clinical oversight.…

Commissioners Reassess and Recommit to Improving Health Care for Foster Children The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to revisit how Medicaid meets the unique health care needs of children in foster care, building on its 2015 examination of the intersection between Medicaid and child welfare. The session involved a…

Commissioners Explore Challenges and Opportunities in Self-Directed Home and Community-Based Services The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to explore interview findings on program design and administration of self-directed services in Medicaid Home- and Community-Based Services (HCBS), which allow individuals with long-term care needs to live independently in their communities.…

Commissioners Support Draft Policy Recommendations Focused on the Challenges of Transitions of Care for Children and Youth with Special Health Care Needs The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to present draft policy options aimed at addressing the challenges faced by children and youth with special health care needs (CYSHCN)…

Health Subcommittee Reexamines PBM Reform; Democrats Focus on Impact of Potential Medicaid Cuts The Energy and Commerce (E&C) Health Subcommittee convened a hearing to examine pharmacy benefit manager (PBM) practices and discuss bipartisan reform efforts. The following witnesses spoke to certain PBM practices that inhibit the ability of patients, pharmacies, and employers to obtain affordable…

Committee Republicans Issue RFI on Data Privacy and Security Framework; Comments Due April 7 The House Committee on Energy and Commerce, led by Chairman Brett Guthrie (R-KY) and Vice Chairman John Joyce, M.D. (R-PA), issued a Request for Information (RFI) to gather input on a federal comprehensive data privacy and security framework. The Committee is…

President Trump Issues Executive Orders on Deregulation and Federal Government Downsizing; Aims to Eliminate Advisory Committees on Long COVID and Health Equity President Trump issued two significant executive orders aimed at restructuring the federal government and reducing regulatory oversight. These directives emphasize the administration’s commitment to reducing the size and influence of the federal bureaucracy,…

Department Rescinds Gender-Affirming Care Guidance and Issues New Biological Sex Definitions The Department of Health and Human Services (HHS) announced significant policy shifts in alignment with executive orders (EOs) issued by President Trump. The agency rescinded prior guidance on gender-affirming care and released new directives emphasizing biological sex definitions. These actions reflect the administration’s position…

FTC Announces New HSR Thresholds and Filing Fees for 2025; Effective February 10 The Federal Trade Commission (FTC) recently announced updated jurisdictional thresholds and a revised filing fee schedule for reporting transactions under the Hart-Scott-Rodino (HSR) Act, effective February 10, 2025 (press release). Under the Clayton Act, the FTC is required to adjust HSR thresholds…

Agency Finalizes Reforms to ACA Marketplace for 2026: Higher User Fees, Safeguards Against Fraud, Simplified Plan Choice, and More The Centers for Medicare and Medicaid Services (CMS) released the HHS Notice of Benefit and Payment Parameters for 2026 final rule (fact sheet) – a wide-ranging rule affecting Marketplaces, qualified health plans in the individual and…