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Wednesday, May 27 · 31 stories
- Federal Policy
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
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
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
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.
- Federal Policy
MACPAC Recommends HCBS Wage Transparency in March 2026 Congressional Report
The Medicaid and CHIP Payment and Access Commission released its March 2026 report to Congress recommending increased wage transparency for home- and community-based services workers. The report also examines behavioral health service delivery in Medicaid and CHIP. MACPAC's recommendations typically inform future CMS policy direction and congressional action on Medicaid financing and program design. Managed care organizations with HCBS and behavioral health contracts should review the full report for potential regulatory or contractual implications.
- Federal Policy
MACPAC Sets 2025-2026 Agenda: Enrollment, Community Engagement Among Policy Priorities
The Medicaid and CHIP Payment and Access Commission announced its analytic agenda for the 2025-2026 meeting cycle, focusing on enrollment and eligibility issues and community engagement requirements. MACPAC's research and recommendations influence congressional appropriations and CMS policy development. The agenda signals potential legislative activity in these areas, particularly relevant for managed care organizations navigating state contract requirements and federal compliance expectations. Plans should monitor MACPAC proceedings for early signals on regulatory direction.
- Federal Policy
MACPAC Seeks Vendors for Medicaid Administrative Data Management and Analysis
The Medicaid and CHIP Payment and Access Commission issued an RFI seeking vendors with experience securely managing and analyzing administrative data for government clients. MACPAC is looking for firms that can handle federal and state Medicaid data sources. This procurement signals MACPAC's ongoing work to strengthen its analytic capacity for monitoring Medicaid program performance, access, and payment policy—work that often informs Congressional deliberations and CMS policy development affecting managed care organizations.
- Federal Policy
MACPAC Recommends Transition Support for Youth with Special Needs in Medicaid
The Medicaid and CHIP Payment and Access Commission released its June 2025 Report to Congress with recommendations to improve care transitions from pediatric to adult providers for Medicaid-covered children and youth with special health care needs. The report addresses a longstanding gap in continuity of care that often results in disrupted treatment and emergency department utilization when beneficiaries age out of pediatric services. Managed care plans should review their pediatric-to-adult transition protocols and network adequacy standards, as Congress may direct CMS to implement new transition requirements following MACPAC's advisory guidance.
- Federal Policy
Trump Administration Executive Actions Target Federal Programs, Legal Challenges Mount
The Trump Administration has issued multiple executive orders reshaping federal operations, with several facing legal challenges for alleged statutory violations. Actions include workforce reductions and changes to federal service delivery. Medicaid managed care organizations should monitor ongoing litigation and potential operational impacts to programs relying on federal oversight, technical assistance, or partner agencies. Legal outcomes will determine which policy changes remain in effect.
- Federal Policy
Congressional Appropriations Guardrails Sought to Limit Executive Medicaid Funding Holds
Advocacy groups are urging Congress to include statutory restrictions in fiscal year 2027 appropriations bills to prevent executive branch holds on federal Medicaid funding. The push responds to administration actions that have delayed or withheld appropriated funds across federal agencies. For Medicaid managed care organizations, appropriations language could affect the timing and certainty of federal matching payments to states, potentially impacting capitation payment schedules and state budget cycles. Any restrictions would take effect with the FY 2027 appropriations process beginning in fall 2026.
- Federal Policy
SNAP Participation Drops 3.5 Million After Republican Bill Implementation
Nationwide SNAP enrollment declined by 3.5 million people (9 percent) between July 2025 and February 2026 following enactment of Republican legislation restricting food assistance eligibility. The enrollment drop affects Medicaid managed care organizations that serve dual-eligible populations and coordinate care for members who rely on both health coverage and nutrition assistance. MCOs should monitor member churn, assess social determinants of health screening protocols, and prepare for increased emergency department utilization among food-insecure enrollees.
- Federal Policy
ICE Operations Threaten Medicaid Enrollment for Children of Detained Immigrants
Increased immigration enforcement operations are creating emergency custody situations that could disrupt Medicaid coverage for children whose parents are detained. Several states are enacting protective measures for these children, but guardianship complications may affect enrollment continuity. Child welfare agencies and MCOs must coordinate to maintain coverage during family separations. This impacts Medicaid managed care plans serving populations with mixed immigration status families.
- Federal Policy
CMS Prepares Guidance on Medical Frailty Exemption Implementation for Medicaid Work Requirements
CMS is expected to issue guidance addressing key implementation questions for the medical frailty exemption from Medicaid work requirements. States are currently developing operational plans but face uncertainty about eligibility criteria, documentation requirements, and assessment processes. The guidance will likely clarify how states should identify and exempt medically frail beneficiaries from work requirements. This affects managed care organizations that may need to modify enrollment processes, develop screening tools, and adjust member engagement strategies based on final CMS standards.
- Federal Policy
KFF Launches Tracker of Trump Administration Mental Health and Substance Use Policies
KFF has released a new tracker documenting federal policy actions during President Trump's second term affecting mental health and substance use services. The tracker shows the administration emphasizing law-and-order approaches while scaling back certain mental health and substance use services, though some treatment-focused initiatives continue. The tool organizes policies chronologically and by category including mental health, opioids/SUD, federal infrastructure, and gun violence. This matters for Medicaid MCOs as federal policy changes in behavioral health directly impact covered services, reimbursement structures, and compliance requirements for mental health and substance use disorder benefits.
- Federal Policy
GAO: VA Improved Cybersecurity for Million Veteran Program After 2025 Recommendations
The Government Accountability Office found that VA has implemented 9 of 13 cybersecurity recommendations made in September 2025 to protect veterans' health information in the Million Veteran Program system. While VA's business associate agreements with external entities fully comply with HIPAA Privacy Rule requirements, GAO identified deficiencies in asset management, configuration management, and access controls that reduced assurance of data confidentiality. The improvements are significant given that MVP contains sensitive health data for approximately 1 million veterans in the nation's largest veteran biorepository. GAO continues monitoring VA's progress on the remaining four recommendations.
- Federal Policy
NASHP Hosts Rural Payment Reform Learning Session for States
The National Academy for State Health Policy (NASHP) is hosting a collaborative learning session on rural payment and delivery reform for state officials on Thursday, May 21 from 2-3 p.m. ET. The session will focus on innovative payment models and delivery strategies for rural healthcare providers. State Medicaid directors and managed care organizations operating in rural markets may gain insights into emerging payment reform approaches and delivery innovations that could inform future contract negotiations and provider network strategies.