Billy Wynne

CMS Innovation Center Cancels Eight Models Ahead of New Strategy Announcement The Center for Medicare & Medicaid Innovation (CMMI) issued a statement announcing certain models will be canceled or end by December 31, 2025. The declaration was made after a review of the model portfolio by the Trump administration, which asserts that models must reduce spending…

Proposed Rule Addresses ACA Marketplace Integrity and Affordability; Comments Due Mid-April The Centers for Medicare and Medicaid Services (CMS) issued the “Marketplace Integrity and Affordability Proposed Rule,” which includes a series of proposals intended to address improper enrollments in Marketplace coverage and reduce improper federal spending on advanced premium tax credits (APTCs) (press release; fact…

Commissioners Explore Preliminary Work on Medigap: Future Analysis to Address Premium Variability, Trends in Medigap Enrollment and the Role of State Guaranteed-Issue Policies The Medicare Payment Advisory Committee (MedPAC) convened a session on preliminary work related to Medigap, the supplemental insurance available to beneficiaries enrolled in fee-for-service Medicare to cover cost-sharing and coinsurance. Commissioners requested background…

CBO Letter Confirms House Budget Resolution Requires Deep Medicaid Cuts While New Poll Data Shows Majority of Americans Opposed to Cutting Medicaid Yesterday, the Congressional Budget Office (CBO) released a letter confirming that the only path to follow the House’s instructions would require deep spending cuts in the Medicaid program. Last month, the House passed…

Commissioners Discuss I-SNPs for Long-Stay Nursing Home Residents The Medicare Payment Advisory Commission (MedPAC) held a meeting to discuss Institutional Special Needs Plans (I-SNPs). This was the second of three sessions this meeting cycle focused on long-stay nursing home residents, the first of which was an overview of the workplan in October 2024 (Impact summary). Chair Michael Chernew…

National Governors Association Releases Statement on Potential Medicaid Cuts  Today, the National Governors Association (NGA)  released a statement expressing concern regarding Medicaid cuts that are currently being considered in Congress as part of Budget Reconciliation.  The statement is from NGA Chair Governor Polis (Colorado) and NGA Vice Chair Governor Stitt (Oklahoma) on behalf of the…

CMS Rescinds Guidance on Medicaid and CHIP Coverage of Health-Related Social Needs (HRSNs);  Annouces Plans to Review Waivers on a Case-by-Case Basis in the Future On March 4, the Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin (CIB) rescinding CMS’ previous 2023 and 2024 guidance on Medicaid and Children’s Health Insurance Program (CHIP) coverage of…

President Trump’s Executive Order Calls for Sweeping Review of Government Contracts and Grants President Trump issued an Executive Order (EO) titled “Implementing the President’s ‘Department of Government Efficiency’ Cost Efficiency Initiative.” This order mandates a comprehensive 30-day review of federal contracts, grants, and loans with the aim of reducing federal spending and reallocating funds to…

Task Force Announces Draft Research Plan for Tobacco Cessation Interventions in Adults; Comments Due March 26 The U.S. Preventive Services Task Force (USPSTF) released a draft research plan on interventions for tobacco cessation in adults. This research plan aims to assess the effectiveness and potential harms of various tobacco cessation methods, including their impact on…

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.…