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Thursday, August 13 · 6 stories
- Federal Policy
CMS Proposes RAPID Pathway for Breakthrough Device Coverage Under Medicare
On August 7, 2024, CMS issued a notice with comment period proposing the Regulatory Alignment for Predictable and Immediate Device (RAPID) Coverage Pathway. The pathway would accelerate Medicare coverage for medical devices receiving FDA breakthrough designation by aligning CMS coverage review with FDA premarket review before market authorization. The proposal aims to reduce the gap between FDA approval and Medicare coverage determinations for qualifying devices. Comments are due following standard notice procedures.
- Federal Policy
CMS Sets October 13 Deadline for APM Participants to Update Billing Information or Forfeit 2026 Payments
CMS issued an advisory requiring certain alternative payment model participants to update taxpayer identification numbers by October 13, 2026, to receive APM incentive payments for the 2026 payment year based on 2024 performance. The agency could not identify valid TINs for some participants after processing payments. Clinicians who fail to submit updated billing information by the deadline will forfeit their APM incentive payments for this payment period.
- Federal Policy
CMS Clarifies Custodial Parents Largely Exempt from Medicaid Work Reporting Requirements
The Centers for Medicare and Medicaid Services released an Interim Final Rule clarifying exemptions from new Medicaid work reporting requirements set to take effect in January 2027. The guidance confirms that most custodial parents and caretaker relatives are excluded from work reporting mandates, addressing widespread confusion as 28 states prepare implementation. The clarification affects state planning and system development currently underway. The IFR provides critical operational guidance for state Medicaid agencies navigating compliance with federal work reporting provisions while minimizing improper coverage terminations for exempt populations.
- Federal Policy
CMS Opens Comment Period for RAPID Device Coverage Pathway, Due October 10
CMS released a notice with comment period on August 7, 2026, establishing the framework for the Regulatory Alignment for Predictable and Immediate Device (RAPID) Coverage Pathway. The pathway aims to accelerate Medicare coverage for innovative medical devices following FDA market authorization. Comments are due October 10, 2026. The pathway creates a streamlined process that shortens the gap between FDA approval and national Medicare coverage for qualifying devices.
- Federal Policy
HRSA Launches Framework to Modernize National Newborn Screening Panel Review Process
The Health Resources and Services Administration announced a new framework on August 11, 2026, to streamline how conditions are evaluated for addition to the national newborn screening panel. The initiative aims to update a review process that officials say has not kept pace with advances in genetic medicine. The framework establishes a standardized pathway for assessing which screenable conditions should be recommended for inclusion. This affects state Medicaid programs and CHIP, which finance newborn screening for the majority of U.S. births and must determine coverage for newly recommended tests.
Wednesday, August 12 · 4 stories
- Federal Policy
Brookings Researchers Challenge CMS Data Underlying Medicaid Work Requirements Rule
Brookings Institution researchers have publicly criticized the data and assumptions CMS used to support its Medicaid work requirements rule, which imposed stricter documentation standards for enrollees claiming medical exemptions from work mandates. The rule, already facing litigation, required beneficiaries to provide more extensive proof of illness or disability to qualify for exemptions than stakeholders anticipated. The Brookings critique alleges CMS misrepresented or manipulated data to justify the policy. This matters because if the agency's analytical foundation is undermined, courts may be more likely to vacate the rule, and CMS may face pressure to withdraw or revise the policy.
- Federal Policy
March of Dimes: 5.8 Million Women Live in Maternity Care Deserts
A March of Dimes report finds that 5.8 million women live in counties without full access to maternity care, with one-third of U.S. counties classified as maternity care deserts — areas lacking hospitals or birth centers offering obstetric services. The report highlights geographic disparities in prenatal and delivery care access nationwide. These gaps affect Medicaid-covered pregnancies, as Medicaid finances approximately 42% of births nationally and faces network adequacy and provider participation challenges in underserved areas.
- Federal Policy · MA
Massachusetts Launches Member Notice Campaign on Federal Medicaid Eligibility Requirements
Massachusetts is mailing notices to MassHealth members this week informing them of federal eligibility requirement changes and actions needed to maintain coverage. Governor Healey characterized the federal requirements as burdensome. The notices aim to help members understand how the changes affect them and what steps they must take to avoid coverage loss. The campaign reflects state efforts to minimize enrollment disruption from new federal compliance mandates.
- Federal Policy
CMS Final Rule Bars Federal Medicaid, CHIP Funds for Pediatric Gender-Affirming Care
CMS issued a final rule prohibiting federal Medicaid and CHIP matching funds for gender-affirming care for minors, including puberty blockers, hormone therapy, and related surgeries such as mastectomies. The rule takes effect October 13, 2026. States will no longer receive federal financial participation for these services furnished to children enrolled in Medicaid or CHIP. The policy represents a federal prohibition on a category of care previously covered under state Medicaid programs' Early and Periodic Screening, Diagnostic and Treatment benefit and other authorities.
Tuesday, August 11 · 6 stories
- Federal Policy
Sequoia Project Names 19 Members to TEFCA Governing Council
The Sequoia Project updated its TEFCA Governing Council roster on August 10, 2026, naming 19 representatives from health systems, health information networks, technology vendors, and federal agencies. TEFCA is the ONC-overseen national framework for exchanging health data across qualified health information networks. The Governing Council advises on implementation and policy for the framework. The update reflects ongoing governance structure for the national interoperability initiative.
- Federal Policy
Collins Bill Would Reset Medicare Home Health Rates, Expand CMS Fraud Authority
Sen. Susan Collins (R-Maine) introduced legislation to restore Medicare home health payment rates to pre-cut levels and provide CMS with expanded fraud prevention and detection authority. The bill targets home health payment integrity while reversing recent years of Medicare rate reductions. The proposal would affect Medicare home health providers' reimbursement and compliance obligations, though specific effective dates and fraud-fighting mechanisms are not detailed in available reporting. Home health agencies would see financial and operational impact if the bill advances.
- Federal Policy
Federal Government Plans $50 Billion Rural Health AI Initiative Despite Limited Evidence
The federal government is launching a $50 billion Rural Health Transformation Program focused on deploying AI health tools in rural communities. The initiative proceeds despite limited evidence that AI-based healthcare technologies improve access or patient outcomes in rural areas. Patient advocates and rural health experts have expressed concerns about the push for AI solutions without demonstrated effectiveness in underserved communities. The program's implementation timeline and specific Medicaid integration requirements have not been disclosed.
- Federal Policy
Federal Policy Restricts Use of Funds for Fentanyl Test Strips
Federal officials have implemented a policy limiting how funds can be used to purchase fentanyl test strips, a harm reduction tool credited with preventing overdose deaths. The restriction affects organizations providing overdose prevention services, including those responding to mass overdose events. Harm reduction advocates report the policy will make distributing test strips more difficult. Federal officials justify the restriction by asserting the strips enable drug use.
- Federal Policy
Trump Executive Order Revises Federal Childhood Vaccine Schedule, Separates MMR
President Trump signed an executive order on August 10, 2026, revising federal childhood vaccine schedules by requiring separate measles, mumps, and rubella shots instead of the combined MMR vaccine and narrowing the list of immunizations recommended for all children. The order, titled Gold Standard Childhood Vaccine Recommendations, affects the federally recommended schedule that state Medicaid programs and health plans use for EPSDT coverage determinations. The changes take effect immediately for federal guidance, though state Medicaid agencies will need to determine whether and how quickly to align coverage policies with the revised schedule. This matters for state agencies and health plans because EPSDT requires coverage of ACIP-recommended vaccines, and any federal schedule changes trigger operational questions about coverage mandates, provider network readiness, and member communication.
- Federal Policy · WA
HHS Declares Public Health Emergency for Washington Wildfires, Enabling Section 1135 Waivers
HHS Secretary Robert F. Kennedy Jr. declared a public health emergency for Washington state on August 7, 2026, following President Trump's emergency declaration on August 4. The dual declarations enable Washington to request Section 1135 waivers, which allow temporary flexibility from certain Medicare, Medicaid, and CHIP regulatory requirements during the wildfire emergency. The Administration for Strategic Preparedness and Response has deployed regional staff to support state response efforts, and the Washington State Hospital Association is providing resources to assist providers.
Monday, August 10 · 2 stories
- Federal Policy
Congressional Republicans Question State Use of Enhanced Federal Medicaid Matching Funds
Congressional Republicans have raised concerns about states leveraging increased federal matching dollars from Medicaid expansion, provider taxes, and state directed payments to grow their Medicaid budgets. The lawmakers argue that states are not adequately considering the fiscal impact on the federal government when utilizing these funding mechanisms. This scrutiny comes as Congress examines Medicaid financing structures and potential reforms to federal matching formulas. The development signals potential legislative or oversight activity that could affect state Medicaid financing strategies and the availability of enhanced federal matching rates.
- Federal Policy
CMS Official Issues Letter to Rural Health Transformation Grant Recipients
A CMS official has addressed Medicaid directors and state leaders who received Rural Health Transformation grant funding. The letter discusses priorities for improving care delivery in rural communities. It is directed at states and stakeholders managing RHT grant implementation. The communication signals federal expectations for how awarded jurisdictions should approach rural health system improvements under the initiative.
Friday, August 7 · 3 stories
- Federal Policy
CMS Releases FY 2027 IPPS Final Rule
On July 31, 2026, CMS issued the FY 2027 Inpatient Prospective Payment System (IPPS) final rule. The rule sets Medicare payment rates and policies for inpatient hospital services for the fiscal year beginning October 1, 2026. While the IPPS primarily governs Medicare payments, the rule's rate methodologies and quality measures often influence Medicaid supplemental payment programs, state upper payment limit calculations, and hospital financial stability that affects Medicaid providers. The rule takes effect October 1, 2026.
- Federal Policy
CMS Releases FFY 2027 IPPS and LTCH Final Rule
On August 4, 2026, CMS published its final rule updating payment rates and policies for the inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) for federal fiscal year 2027. The rule takes effect October 1, 2026, the start of FFY 2027. While the rule primarily governs Medicare hospital payments, it may affect Medicaid programs that use Medicare rates as a baseline for supplemental payments, upper payment limit calculations, or rate-setting for Medicaid managed care hospital contracts.
- Federal Policy
CMS Finalizes FY 2027 SNF PPS Rule With Payment Updates and MDS Reporting Changes
CMS published its final rule updating Medicare payment rates and policies for skilled nursing facilities under the SNF PPS for federal fiscal year 2027, effective October 1, 2026. The rule includes a payment rate increase, revisions to the Skilled Nursing Facility Quality Reporting Program (QRP), and expanded Minimum Data Set (MDS) reporting requirements. The changes affect SNF reimbursement levels, quality reporting obligations, and administrative requirements for facilities participating in Medicare. For Medicaid programs, these changes may influence state rate-setting for dual-eligible beneficiaries and facility operations where Medicare and Medicaid patients receive services in the same settings.