Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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Federal Policy·9d ago

CMS Seeks Comment on Generic Clearance for State Plan Amendments and Waiver Information Collections

CMS has published a Federal Register notice requesting public comment on one or more information collection requests under its existing Paperwork Reduction Act generic clearance umbrella (control number 0938-1148). The umbrella, approved in April 2021, covers Medicaid and CHIP state plan amendments, waivers, demonstrations, and reporting requirements. Comments are due 60 days from publication. The generic clearance process allows CMS to expedite approval of voluntary, low-burden information collections that do not raise substantive policy issues, streamlining the agency's ability to request information from states without full PRA review for each individual collection.

Federal Policy·9d ago

CMS Re-Establishes Data Match With Treasury Do Not Pay System

CMS has re-established a computer matching program with the U.S. Department of the Treasury's Do Not Pay Working System, administered by the Bureau of Fiscal Service. The match enables CMS to verify payment eligibility and prevent improper payments across Medicare and Medicaid by cross-referencing beneficiary and provider data against federal databases tracking death records, excluded parties, and debarred entities. The re-establishment continues an existing fraud prevention tool used by CMS to support program integrity efforts. The match affects CMS payment operations and supports state Medicaid agencies' ability to identify ineligible providers or payments flagged through federal screening.

Federal Policy·17d ago

CMS Renews DNV Healthcare Recognition as Hospital Accrediting Organization

CMS has approved DNV Healthcare USA Inc.'s application for continued recognition as a national accrediting organization for hospitals seeking Medicare or Medicaid participation. The approval allows DNV to continue surveying hospitals for compliance with CMS Conditions of Participation. The renewal takes effect September 17, 2026. This maintains DNV's status as one of several deemed status organizations that perform accreditation surveys in lieu of direct CMS or state agency surveys.

Federal Policy·25d ago

CMS Renames Hospice Item Set System to HOPE, Adds Real-Time Data Collection

CMS is modifying its existing Hospice Item Set (HIS) System of Records, renaming it the Hospice Outcomes and Patient Evaluation (HOPE) system. The change adds real-time data collection at the time of patient assessments to improve understanding of care needs and coordination. The system collects standardized hospice patient data for quality measurement, regulatory compliance, reporting, research, and policy functions. This Privacy Act notice reflects expanded data collection practices for hospice providers under federal oversight.

Federal Policy·45d ago

CMS Establishes Privacy Act System for Nurses for Nursing Homes Program

CMS is establishing a new Privacy Act system of records for the Nurses for Nursing Homes Program (NNHP), which will collect personally identifiable information on individuals who apply for, participate in, or support the program. Records will include demographic data, professional licensure, education and training information, employment and nursing facility affiliation, payment information, and tax reporting. The system supports administration of a nursing workforce incentive program designed to strengthen staffing at Medicare and Medicaid-certified nursing homes, with a focus on underserved and rural communities. The notice was published August 20, 2026.

Federal Policy·60d ago

CMS Re-Establishes Data Matching Program With Department of War for ACA Coverage Verification

CMS is re-establishing a Privacy Act matching program with the Department of War to verify minimum essential coverage under the Affordable Care Act through War Department health benefit plans. The matching program allows CMS to cross-reference enrollment data to confirm ACA coverage requirements are met. The notice was published August 5, 2026, under Privacy Act requirements. This routine administrative action maintains existing data-sharing arrangements between federal agencies for coverage verification purposes.

Federal Policy·61d ago

CMS Issues FY 2027 IPPS Final Rule With GME, LTCH, and Quality Reporting Changes

CMS published its final rule updating Medicare inpatient prospective payment systems for acute care hospitals and long-term care hospitals for fiscal year 2027, effective October 1, 2026. The rule revises operating and capital payment rates, modifies graduate medical education policies for teaching hospitals, updates LTCH PPS rates, and changes requirements for hospital quality reporting programs. HHS also adopts updated health IT standards. While this is a Medicare rule, Medicaid managed care organizations and state agencies should monitor GME policy changes and quality measure updates that often influence Medicaid hospital payment methodologies and managed care contract requirements.

Federal Policy·61d ago

CMS Announces Healthcare Advisory Committee Virtual Meetings for FY 2026-2027

CMS has announced virtual public meetings of the Healthcare Advisory Committee (HAC) for fiscal year 2026-2027. The Committee advises the HHS Secretary and CMS Administrator on healthcare system improvements consistent with the Executive Order establishing the President's Make American Healthy Again Commission. The meetings are open to public participation. The announcement provides stakeholders advance notice of opportunities to observe federal healthcare policy deliberations.

Federal Policy·67d ago

CMS Re-Establishes Data Match With OPM for Marketplace and Medicaid Eligibility Verification

CMS has re-established a Privacy Act matching program with the Office of Personnel Management to verify minimum essential coverage through OPM health benefit plans. The data match enables CMS and State Administering Entities to determine eligibility for qualified health plans through exchanges and insurance affordability programs, including Medicaid and CHIP. The match supports initial eligibility determinations, renewals, redeterminations, and appeals. Effective July 29, 2026, this routine data exchange ensures states can verify coverage status when individuals apply for Medicaid or marketplace subsidies.

Federal Policy·68d ago

CMS Publishes Q2 2026 Quarterly Listing of Medicare and Medicaid Program Issuances

CMS published its quarterly compilation of manual instructions, regulations, and Federal Register notices issued between April and June 2026 for Medicare, Medicaid, and other CMS-administered programs. This is a routine administrative notice that compiles previously issued guidance and rulemakings from the quarter into a single reference document. The listing provides a consolidated index of policy issuances for stakeholders tracking program changes. This quarterly publication serves as an administrative record and reference tool rather than announcing new policy.

Federal Policy·73d ago

CMS Announces Public Data Release Under OPEN Government Data Act

CMS will release new public data assets in machine-readable formats under the OPEN Government Data Act, part of the Foundations for Evidence-Based Policymaking Act of 2018. The data release aims to support fraud, waste, and abuse identification while promoting transparency and accountability. CMS states it has balanced transparency objectives with protection of sensitive information. The notice does not specify which datasets will be released or when they will become available.

Federal Policy·75d ago

HHS Corrects Technical Errors in 2027 ACA Payment Parameters Final Rule

The Department of Health and Human Services published a correction to the 2027 Notice of Benefit and Payment Parameters final rule, originally issued May 20, 2026. The correction addresses typographical errors in the rule governing qualified health plan standards, risk adjustment, and the Basic Health Program. These are technical corrections only and do not change the substantive policy or operational requirements established in the May rule. The corrections are effective immediately upon publication.

Federal Policy·79d ago

CMS Proposes CY 2027 Physician Fee Schedule with Part B Payment and Quality Program Updates

CMS published a proposed rule updating the physician fee schedule for calendar year 2027, along with changes to Medicare Part B payment policies, Quality Payment Program requirements, and Medicare Shared Savings Program rules. The proposal also codifies the Medicare Prescription Drug Inflation Rebate Program established under the Inflation Reduction Act of 2022 and updates policies for rural health clinics, federally qualified health centers, ambulance services, and clinical laboratory fee schedules. While primarily Medicare-focused, the rule affects providers participating in both Medicare and Medicaid managed care networks, potentially impacting provider contracting, rate negotiations, and network adequacy for dual-eligible populations. Comments are due 60 days after Federal Register publication.

Federal Policy·79d ago

CMS Seeks Comment on Generic Medicaid and CHIP Information Collection Activities

The Centers for Medicare & Medicaid Services is requesting public comment on proposed generic information collection activities under control number 0938-1148 (CMS-10398). The generic clearance process covers low-burden, voluntary collections related to Medicaid and CHIP state plan amendments, waivers, demonstrations, and reporting. Comments are due 60 days after publication in the Federal Register on July 16, 2026. The umbrella approval allows CMS to expedite certain data requests without full Paperwork Reduction Act review when collections do not raise substantive policy issues.

Federal Policy·86d ago

CMS Approves Joint Commission for Continued HHA Accreditation Through 2026

CMS has approved The Joint Commission for continued recognition as a national accrediting organization for home health agencies seeking Medicare or Medicaid participation. The approval is effective July 10, 2026. Joint Commission-accredited HHAs are deemed to meet Medicare Conditions of Participation and Medicaid provider standards. This decision maintains the existing accreditation pathway for home health agencies providing services under managed care contracts and fee-for-service arrangements.

Federal Policy·89d ago

CMS Re-Establishes Data Match With VA to Verify Minimum Essential Coverage for Marketplace Eligibility

CMS has re-established a data matching program with the Department of Veterans Affairs to verify whether Marketplace applicants are enrolled in VA health care programs that constitute minimum essential coverage. The match allows CMS to determine eligibility for Insurance Affordability Programs by checking VA enrollment status. The program takes effect July 7, 2026, under Privacy Act requirements. This represents continuation of an existing verification process used in Marketplace eligibility determinations.

Federal Policy·93d ago

CMS and VA Launch Data Match to Verify Marketplace Subsidy Eligibility

CMS is establishing a new Privacy Act computer matching program with the Department of Veterans Affairs to verify eligibility for insurance affordability programs under the Affordable Care Act. The data match will allow CMS to cross-check applicant information against VA records to confirm subsidy eligibility for Marketplace coverage. The matching program follows standard Privacy Act protocols requiring advance notice before implementation. This affects how eligibility is determined for individuals who may qualify for both VA benefits and Marketplace subsidies, though it does not directly alter Medicaid managed care operations.

Federal Policy·108d ago

CMS Seeks Input on PBM Compensation Restrictions and Data Reporting for 2028 Implementation

CMS issued a request for information on pharmacy benefit manager compensation structures and business practices to inform implementation of new legislative requirements. The RFI focuses on two mandates taking effect in 2028: restrictions on remuneration PBMs and affiliates may receive for services related to Part D drug utilization, and new data reporting requirements. CMS is seeking technical input on PBM service arrangements, affiliate relationships, and compensation models. Comments will shape how CMS defines permissible PBM compensation and structures data collection requirements for Medicare Part D plans.

Federal Policy·109d ago

CMS Proposes Rule to Codify Medicare Drug Price Negotiation Program

CMS has issued a proposed rule to codify the Medicare Drug Price Negotiation Program and establish new policies for both the Negotiation Program and the Medicare Prescription Drug Benefit Program as required by the Inflation Reduction Act of 2022. The rule also proposes modifications to the fixed combination drug policy. The Negotiation Program allows Medicare to negotiate prices for certain high-cost drugs, which could affect formulary dynamics and pricing strategies for Medicare Advantage plans that include prescription drug coverage. The proposed rule sets the framework for how negotiated prices will be implemented and administered.

Federal Policy·115d ago

CMS Establishes Office of Health Technology and Products to Oversee Technology Modernization

CMS has created the Office of Health Technology and Products (OHTP) to lead enterprise-wide healthcare technology modernization and digital transformation across Medicare, Medicaid, CHIP, and other CMS programs. The office will oversee digital products and platforms in coordination with the CMS Chief Information Officer, who retains governance authority over IT infrastructure, cybersecurity, and enterprise architecture. The organizational change takes effect immediately through this statement of delegations. The new structure may affect how states and managed care organizations interact with CMS technology systems and digital service delivery initiatives.

Legal·124d ago

Court Vacates Gender Identity Protections in Section 1557 Nondiscrimination Rule

On October 22, 2025, the U.S. District Court for the Southern District of Mississippi vacated provisions of HHS's May 2024 Section 1557 final rule that expanded Title IX's sex discrimination definition to include gender identity discrimination. The vacated provisions are legally void. All other provisions of the Section 1557 nondiscrimination rule remain in effect. The ruling affects how Medicaid managed care organizations must handle gender identity-related coverage determinations, prior authorization policies, and grievance procedures under federal nondiscrimination requirements.

Federal Policy·129d ago

CMS Recharters Medicare Lab Test Advisory Panel, Announces July 2026 Meeting

CMS has rechartered the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests and appointed five new members. The panel will meet July 14-15, 2026, to advise HHS and CMS on clinical diagnostic laboratory test issues under Medicare. While focused on Medicare, decisions on laboratory test coverage and payment often influence Medicaid managed care plan policies for diagnostic services, particularly for dual-eligible populations and carve-in lab benefits. State Medicaid programs frequently align lab fee schedules and coverage criteria with Medicare determinations.

Federal Policy·129d ago

CMS Finalizes 2027 Exchange Payment Parameters, Expands Hardship Exemptions, Revises QHP Standards

CMS issued final 2027 benefit and payment parameters for federally-facilitated exchanges, modifying risk adjustment methodology, HHS-RADV processes, and user fee rates for QHP issuers. The rule codifies expanded hardship exemption eligibility, establishes new provider access and essential community provider standards for QHP certification, prohibits routine non-pediatric dental services as essential health benefits, and allows catastrophic plans with up to 10-year terms. Changes take effect for plan year 2027. While focused on individual and small group exchange markets, provisions affecting network adequacy standards, civil money penalties, and broker oversight may inform state Medicaid managed care oversight frameworks.

Federal Policy·129d ago

CMS Corrects Technical Errors in FY 2027 IPPS Proposed Rule

CMS issued a correction notice for technical and typographical errors in the FY 2027 Hospital Inpatient Prospective Payment System proposed rule published April 14, 2026. The correction addresses errors in the original proposed rule covering Medicare payment rates for acute care hospitals and long-term care hospitals, along with quality program requirements. Stakeholders reviewing the proposed rule for comment should incorporate these corrections when preparing submissions. While this is a Medicare-focused rule, Medicaid managed care organizations with dual-eligible populations or Medicare Advantage Special Needs Plans should monitor for cross-program policy implications affecting hospital contracting and quality metrics.

Federal Policy·129d ago

CMS Opens 60-Day Comment Period on Information Collection Request

The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection activity under the Paperwork Reduction Act of 1995. The agency is soliciting public comments on burden estimates, necessity and utility of the proposed collection, accuracy of burden estimates, and ways to enhance data quality or reduce reporting burden through automation. Comments are due 60 days from publication. This matters for MCOs because information collection requirements often translate to new reporting obligations, quality measure submissions, or encounter data specifications that affect plan operations and compliance costs.

Federal Policy·129d ago

CMS Seeks Comment on Medicaid and CHIP Generic Paperwork Clearance Process

The Centers for Medicare & Medicaid Services is requesting public comment on information collection activities under its generic Paperwork Reduction Act clearance process (control number 0938-1148). The umbrella approval, last renewed in April 2021, covers voluntary, low-burden data collection related to Medicaid and CHIP state plan amendments, waivers, demonstrations, and reporting. CMS is inviting stakeholders to comment on burden estimates, necessity of proposed collections, and opportunities to reduce administrative requirements. Comments are particularly relevant for states and managed care organizations that submit routine program updates and compliance documentation to CMS.

Federal Policy·129d ago

CMS Opens 60-Day Comment Period on Paperwork Reduction Act Information Collection

CMS announced a Federal Register notice seeking public comment on a proposed information collection under the Paperwork Reduction Act. The agency is soliciting feedback on burden estimates, necessity of the collection, and ways to streamline reporting requirements. Comments are due 60 days from publication. This notice matters to Medicaid managed care organizations because PRA collections often involve reporting requirements for health plans, including quality measures, encounter data, or network adequacy documentation that affect operational compliance costs.

Federal Policy·129d ago

CMS Opens 60-Day Comment Period on Proposed Information Collection Requirements

The Centers for Medicare & Medicaid Services is soliciting public comment on a proposed information collection under the Paperwork Reduction Act. The 60-day comment period allows stakeholders to weigh in on burden estimates, necessity of the collection, and potential use of automation to reduce reporting burden. CMS has not specified which programs or reporting requirements are affected in this notice. Managed care organizations should monitor the Federal Register for details on whether MCO reporting, quality measures, or network adequacy documentation are subject to this collection.

Federal Policy·129d ago

CMS Imposes 6-Month Nationwide Moratorium on New Hospice Enrollment

CMS has announced a 6-month nationwide moratorium on enrollment of new hospice providers in Medicare, Medicaid, and CHIP. The temporary suspension prevents new hospice agencies from enrolling or re-enrolling during the moratorium period. Existing hospice providers can continue operations and current Medicaid managed care networks are unaffected. The action reflects CMS efforts to address fraud, waste, and abuse in hospice services, which may impact managed care organizations' ability to contract with new hospice providers during this period.

Federal Policy·129d ago

CMS Imposes 6-Month Nationwide Moratorium on Home Health Agency Medicare Enrollment

CMS has announced a 6-month nationwide moratorium on the enrollment of new home health agencies in the Medicare program. The moratorium applies to HHA enrollment applications and prevents new agencies from billing Medicare during the suspension period. This action follows established regulatory authority to impose temporary enrollment moratoria when fraud, waste, or abuse concerns exist. The moratorium affects providers seeking Medicare participation but does not directly impact Medicaid managed care plans, though dual-eligible care coordination and LTSS network adequacy planning may be indirectly affected in markets with limited HHA capacity.

Federal Policy·129d ago

CMS Publishes Q1 2026 Quarterly Listing of Medicare and Medicaid Program Issuances

CMS has released its quarterly compilation of manual instructions, regulations, and Federal Register notices published from January through March 2026 affecting Medicare, Medicaid, and other CMS-administered programs. This index provides a consolidated reference for all policy guidance issued during the quarter, helping managed care organizations and state agencies track regulatory changes across multiple program areas. The listing includes substantive and interpretive regulations that may affect MCO operations, compliance requirements, and state plan administration. Compliance officers should review the index to identify any guidance affecting their contracts or service areas that may have been issued during the first quarter.

Federal Policy·129d ago

CMS Announces First Healthcare Advisory Committee Meeting for May 2026

The Centers for Medicare & Medicaid Services has announced the inaugural meeting of the Healthcare Advisory Committee (HAC) scheduled for May 18, 2026. The Committee will advise the HHS Secretary and CMS Administrator on healthcare system improvements pursuant to an Executive Order establishing the President's Make American Healthy Again Commission. The virtual meeting is open to the public. While the Committee's scope appears broad, its recommendations could influence future Medicaid managed care policy directions including quality measures, value-based payment models, and program integrity standards.

Federal Policy·129d ago

CMS Opens Public Comment on Medicaid Information Collection Requirements

The Centers for Medicare & Medicaid Services is soliciting public comments on proposed information collection activities under the Paperwork Reduction Act. This notice provides a second opportunity for stakeholders to comment on reporting burden estimates, data collection utility, and potential automation of collection processes. Comments are being accepted for submission to the Office of Management and Budget. Managed care organizations should review whether any proposed collections affect their existing reporting obligations or create new compliance requirements.

Federal Policy·129d ago

CMS Reopens Comment Period on Medicaid Eligibility Template After Posting Error

CMS is reopening the comment period for 12 days on a previously published information collection notice after discovering an error in posting the S89 citizenship and noncitizen eligibility template under Medicaid State Plan Eligibility. The original notice published April 22, 2026, with a 14-day comment period. This affects state Medicaid agencies and managed care organizations that rely on these standardized templates for eligibility determinations and enrollment processes. The reopening provides stakeholders additional time to review the corrected template and submit comments on its operational impact.

Federal Policy·129d ago

CMS Opens OMB Comment Period on Paperwork Reduction Act Information Collection

CMS has published a Federal Register notice announcing a second public comment opportunity for proposed information collection activities under the Paperwork Reduction Act of 1995. The notice invites stakeholders to comment on burden estimates, necessity and utility of the proposed collections, and ways to reduce reporting requirements through automation or other means. Comments must be submitted to OMB during the specified comment period. This routine procedural notice affects Medicaid managed care organizations only if the specific information collection relates to MCO reporting, quality measurement, or compliance documentation.

Federal Policy·129d ago

CMS Opens 60-Day Comment Period on Paperwork Reduction Act Information Collection

The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection activity under the Paperwork Reduction Act of 1995. The agency is seeking public comment on burden estimates, necessity and utility of the collection, and ways to enhance data quality or reduce reporting burden through technology. The 60-day comment period is now open. This procedural notice affects any entities subject to CMS reporting requirements, though the specific collection instrument and affected programs are not identified in this excerpt.

Federal Policy·129d ago

CMS Opens Public Comment on Information Collection Activities Under Paperwork Reduction Act

CMS announced a Federal Register notice seeking public comment on proposed information collection activities under the Paperwork Reduction Act of 1995. The notice covers proposed extensions or reinstatements of existing data collection requirements and invites feedback on burden estimates, necessity of the collections, and ways to reduce reporting burden through automation or other means. Comments are being solicited during the OMB review period. This is a routine procedural notice that may affect MCO reporting requirements if specific collections relate to managed care data submissions.

Federal Policy·129d ago

CMS Schedules September 2026 Medicare Lab Fee Panel Meeting

CMS announced a public meeting of the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests for September 15-16, 2026. The panel will review and recommend payment methodologies (crosswalking or gapfilling) for laboratory tests that lacked applicable pricing data during the May-July 2026 reporting period under the Clinical Laboratory Fee Schedule. Public stakeholders may present payment recommendations and supporting data before the panel advises CMS on Medicare reimbursement rates. While this concerns Medicare fee-for-service laboratory payments, Medicaid managed care organizations should monitor these rate-setting discussions as Medicare pricing often serves as a benchmark for Medicaid supplemental payments and influences lab contract negotiations.

Federal Policy·129d ago

CMS Opens 60-Day Comment Period on Information Collection Under Paperwork Reduction Act

The Centers for Medicare & Medicaid Services has published a Federal Register notice announcing a proposed information collection activity under the Paperwork Reduction Act of 1995. CMS is seeking public comment on burden estimates, necessity and utility of the data collection, and methods to minimize reporting burden. The 60-day comment period is now open for stakeholders to submit feedback on the proposed collection, extension, or reinstatement. Managed care organizations should review the specific collection requirements to assess potential reporting obligations.

Federal Policy·129d ago

CMS Opens Comment Period on Information Collection Requirements Under PRA

CMS is seeking public comment on proposed information collection activities under the Paperwork Reduction Act of 1995. The notice provides stakeholders an opportunity to comment on burden estimates, necessity of data collection, and potential ways to streamline reporting requirements. Comments may address accuracy of estimated burden, methods to enhance data quality, and use of automated collection techniques. This affects any entities required to submit data to CMS, including managed care organizations subject to reporting requirements.

Federal Policy·129d ago

CMS Proposes 2028 HCBS Quality Measure Set With New Stratification Requirements

CMS released a notice seeking comment on the 2028 Home and Community-Based Services Quality Measure Set, proposing mandatory and voluntary quality measures for state Medicaid HCBS programs. The proposal includes new requirements for states to report stratified data by rural/urban status and other factors, along with specific reporting schedules and calculation methodologies. States and managed care organizations operating HCBS programs must review which measures become mandatory, what populations require reporting, and how stratification requirements affect current data collection systems. Comments are due on the proposed measure set, data collection methods, stratification factors, and reporting timelines.

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