Federal Policy·8:47 AM MT
The Partnership for Medicaid released recommendations for CMS and states on implementing community engagement requirements under H.R. 1. The guidance addresses operational considerations for managed care organizations tasked with verifying beneficiary compliance and coordinating exemptions. Implementation timelines and specific federal guidance remain pending. This matters because MCOs will likely bear responsibility for tracking work requirements, exemption processes, and related reporting — operational burdens that require system changes, vendor coordination, and potential contract amendments.
Why it matters for managed careMCOs will face new operational requirements for verifying beneficiary work activity, managing exemptions, and reporting compliance under H.R. 1 community engagement provisions.
Federal Policy·12:00 AM MT
The HHS Office of Inspector General released its quarterly comparison of Average Sales Prices (ASP) and Average Manufacturer Prices (AMP) for drugs covered under Medicare Part B for the fourth quarter of 2025. This routine report tracks whether ASPs exceed AMPs by specified thresholds, which can trigger federal payment adjustments under the Deficit Reduction Act. The data covers physician-administered drugs reimbursed through Medicare Part B fee-for-service, not Medicaid managed care pharmacy benefits. These quarterly reports are published regularly and do not indicate new policy changes or enforcement actions.
Why it matters for managed careThis Medicare Part B pricing report has no direct operational impact on Medicaid managed care organizations, which use different reimbursement methodologies for physician-administered drugs and do not rely on ASP-based pricing for covered pharmacy benefits.