The Medicaid and CHIP Payment and Access Commission (MACPAC) held a panel session focused on the use of automation and artificial intelligence (AI) in the Medicaid prior authorization process. The discussion explored how these technologies are currently being implemented, their potential to improve efficiency, and the implications for payers, providers, and beneficiaries. Panelists included Dr. Sanmi Koyejo of Stanford University,… (Colocho, April 11, 2025) #Health Information Technology

The Medicare Payment Advisory Committee (MedPAC) convened a session to assess the utilization and delivery of supplemental benefits in Medicare Advantage (MA). This meeting followed a session in October focused on the background and plan financing of supplemental benefits (Impact summary). The staff presentation highlighted that it is difficult to assess the value provided by spending on supplemental benefits because of the limitations… (McClurg, April 11, 2025) #Medicare Advantage

Today, the Medicare Payment Advisory Committee (MedPAC) convened its third session this cycle about the long-stay nursing home population. The Commission previously reviewed its workplan for the topic in October (Impact summary) and discussed Institutional Special Needs Plans (I-SNPs) in March (Impact summary). Today’s session focused on long-standing concerns about the quality of care this population receives in nursing homes…. (Testa, April 11, 2025) #Long-Term Care, #Quality, #Readmissions, #Skilled Nursing Facilities, #Workforce

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to review a draft chapter for the June 2025 Report to Congress on the Program of All-Inclusive Care for the Elderly (PACE) – a fully integrated Medicare-Medicaid program that serves adults ages 55 and older with nursing facility level of care needs while allowing them to live in… (Llamas, April 10, 2025) #Dual Eligibles

CMS issued a press release describing the new Administrator for the Center for Medicare & Medicaid’s vision and his role in the “Make America Healthy Again” agenda. The release describes a focus on modernizing Medicare, the Marketplaces, and Medicaid, including empowering Americans with personalized health solutions and greater cost transparency, as directed by the President’s Executive Order. Under Dr. Mehmet Oz’s leadership, CMS… (Testa, April 10, 2025) #Chronic Diseases, #Costs, #Nutrition, #Prevention, #Program Integrity, #Transparency, #Wellness

The Government Accountability Office (GAO) released a study addressing ongoing drug shortages in the United States, which have been significantly exacerbated by the COVID-19 pandemic. Although the types of drugs in shortage remain consistent with pre-pandemic patterns, the report underscores how the pandemic deepened existing supply chain vulnerabilities, particularly in essential areas like oncology and injectable drugs. While the number… (Eisen, April 9, 2025) #Drug Pricing, #Food and Drug Administration

The House Ways and Means (W&M) Health Subcommittee convened a hearing on the health of the biosimilar market and how increased access to such products can lower prescription drug costs for patients. The following witnesses spoke to the market distortions that impact the biosimilar market, including the tendency for insurers and pharmacy benefit managers (PBMs) to provide preferential formulary placement… (Slifer, April 8, 2025) #Biosimilars, #Prescription Drugs

the Centers for Medicare and Medicaid Services (CMS) announced the Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate Announcement) (press release and fact sheet) and the Final CY 2026 Part D Redesign Program Instructions (fact sheet). What it is. The Rate Announcement addresses a wide array of MA and Part… (Slifer, April 7, 2025) #Demonstration Programs, #Medicare Advantage, #Medicare Part D, #Prescription Drugs, #Risk Adjustment

The Centers for Medicare and Medicaid Services (CMS) released the Contract Year (CY) 2026 Policy and Technical Changes to the Medicare Advantage (MA) program and Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE) final rule (fact sheet). What it is. The final rule includes policies aimed at meeting… (Slifer, April 4, 2025) #Dual Eligibles, #Medicare Advantage, #Medicare Part D, #Prescription Drugs, #Risk Adjustment

The US Department of Agriculture (USDA) announced a set of steps that it will take to bring states into compliance with timeliness requirements for Supplemental Nutrition Assistance Program (SNAP) application processing. USDA issued a letter to state agencies demanding that they take immediate action to address delays in processing applications and recertification. 33 state agencies are out of compliance with timeliness requirements for… (McClurg, April 3, 2025) #Nutrition, #Program Integrity