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Thursday, May 28 · 36 stories
- Industry
Enhanced Premium Tax Credits Expire, Raising Marketplace Premiums for Low-Income Enrollees
Enhanced premium tax credits (ePTCs) for ACA Marketplace plans expired December 31, 2024, after Congress failed to extend the subsidy enhancement. Average monthly out-of-pocket premiums increased for millions of enrollees following the January 31 close of Open Enrollment. The expiration particularly affects low-income individuals who may have been previously eligible for both Marketplace subsidies and Medicaid, creating potential churn between coverage programs as affordability deteriorates.
- Federal Policy
NHeLP Launches Weekly Medicaid Work Requirements Implementation Tracker
The National Health Law Program has begun publishing a weekly series addressing Medicaid work requirements and implementation issues under the One Big Beautiful Bill Act. The resource aims to help advocates monitor federal and state agency actions as policy changes roll out. The series will provide practical guidance on emerging compliance and operational issues. This matters for MCOs because work requirements typically impose new eligibility verification, enrollment monitoring, and reporting obligations on plans under contract with states implementing these policies.
- Federal Policy
FDA Relaxes Oversight of Blood Pressure Wearables, Raising Clinical Accuracy Concerns
The FDA has relaxed regulatory oversight of wellness wearable devices, allowing blood pressure monitoring technology to enter the market without clinical validation. This policy shift enables consumer devices with unverified accuracy to proliferate, potentially affecting remote patient monitoring programs that Medicaid managed care organizations use for hypertension management and chronic disease monitoring. MCOs relying on wearable data for care management and quality metrics should assess whether their contracted devices meet clinical accuracy standards, particularly for programs serving members with cardiovascular conditions.
- Industry
Trump Drug Pricing Deals Face First Test as New Launches Reveal List Prices
Seventeen pharmaceutical manufacturers that signed most-favored-nation pricing agreements with the Trump administration are beginning to launch new products, providing the first public test of whether these voluntary commitments will constrain launch prices. The agreements, which pledge U.S. list prices will not exceed prices in other developed nations, lack formal enforcement mechanisms and apply only to new products launched after signing. For Medicaid managed care organizations, these launches will reveal whether rebate strategies and supplemental rebate negotiations need adjustment, particularly if launch prices come in lower than historical benchmarks would predict.
- Industry
GSK hepatitis B drug achieves functional cure in 1 in 5 patients
An experimental GSK drug achieved functional cure in approximately 20% of chronic hepatitis B patients in new clinical trial data, significantly outperforming existing treatments. The results represent a potential breakthrough in treating chronic hepatitis B, which affects millions globally and can lead to liver cirrhosis and cancer. For Medicaid managed care organizations, improved hepatitis B treatments could reduce long-term pharmacy costs and downstream complications requiring expensive specialty care, particularly relevant given Medicaid's high enrollment of populations at elevated risk for chronic hepatitis B.
Wednesday, May 27 · 61 stories
- Federal Policy
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.