The Medicare Payment Advisory Commission (MedPAC) released its March 2025 Report to Congress. The first nine chapters review Medicare payment policy, payment adequacy indicators, and the Commission’s recommendations for updating 2026 payments across sectors of fee-for-service (FFS) Medicare. MedPAC recommends higher-than-current-law payment updates for acute care hospitals and physicians, and an update equal to current law for outpatient dialysis facilities…. (Testa, March 13, 2025) #Ambulatory Surgical Centers, #Cost-Sharing, #Costs, #Coverage Decisions, #Home Health, #Hospice, #Hospitals, #Inpatient Rehabilitation Facilities, #Medicare Advantage, #Medicare Part D, #Physicians, #Primary Care, #Quality, #Readmissions, #Risk Adjustment, #Skilled Nursing Facilities

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2025 Report to Congress, with (1) recommendations to improve the transparency and usability of external quality review findings in managed care oversight and accountability (2) using provisional plans of care in support of timely access to home and community-based services (HCBS); and (3) reducing administrative burden related to… (Marceno, March 13, 2025) #Coverage Decisions, #Home Health

The Senate Health, Education, Labor & Pensions (HELP) Committee voted to advance Dr. Martin Makary for Commissioner of the Food and Drug Administration (FDA) and Dr. Jayanta Bhattacharya to serve as Director of the National Institutes of Health (NIH) sending their nominations to the full Senate for confirmation. Dr. Makary was approved in a 14-9 vote, with Democratic Senators Maggie… (Eisen, March 13, 2025) #COVID-19, #Food and Drug Administration, #National Institutes of Health, #Women’s Health, #Workforce

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