The House Ways & Means (W&M) Health Subcommittee convened a hearing to examine challenges in post-acute care access, particularly focusing on Medicare Advantage (MA) plans, Medicaid funding, and nursing home staffing standards. Lawmakers from both parties raised concerns about MA plans’ prior authorization practices and their impact on patient care. Democrats emphasized the risks of proposed Medicaid cuts and the importance… (Eisen, March 12, 2025) #Medicare Advantage, #Rural Health

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 in addition to maintaining or improving quality. The Biden administration sought to position improvements in quality… (Testa, March 12, 2025) #Care Coordination, #Costs, #Delivery Reform, #Demonstration Programs, #Generic Drugs, #Grants, #Primary Care, #Quality

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 sheet).   What it is. The rule proposes revised standards relating to APTC eligibility criteria and… (Llamas, March 11, 2025) #Affordable Care Act, #Insurance Reform

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 information on key aspects of Medigap, including enrollment trends, federal and state regulations, premiums, and loss ratios. The session covered an overview of Medigap, its standardized plan types,… (Colocho, March 7, 2025) #Medigap

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 a budget resolution (H.R. 161) instructing the House Energy and Commerce (E&C) Committee, which has jurisdiction over Medicaid, to reduce federal spending by at least $880 billion. The letter… (Marceno, March 7, 2025) #Costs, #Coverage Decisions

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 emphasized that the Commission will not have a chance to explore all of… (McClurg, March 7, 2025) #Post-Acute Care, #Special Needs Plans

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 55 states and territories NGA represents.  In addition to Medicaid, it also highlights concern… (Joyce, March 6, 2025) #Public Health, #Social Determinants of Health

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 health-related social needs (HRSN).  Per the announcement, CMS will now consider states’ applications to cover HRSN related services and supports on a case-by-case basis. In light of this recission, the recent… (Joyce, March 5, 2025) #Social Determinants of Health

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 align with administration policies. The EO directs agencies to justify and publicly track payments under government contracts, introduce… (Colocho, March 5, 2025) #Grants, #Transparency

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 different populations. The draft plan is open for public comment from February 27, 2025, through March 26, 2025. The USPSTF draft… (Colocho, March 3, 2025) #Chronic Diseases, #Health Equity, #Mental and Behavioral Health, #Prevention, #Public Health, #Tobacco, #Wellness