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Wednesday, May 27 · 61 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.
- Industry
Sen. Durbin Claims Trump Administration Enables Tobacco Marketing to Minors
Senator Dick Durbin criticizes the Trump administration for allegedly allowing tobacco companies to market nicotine products to children. The opinion piece focuses on regulatory enforcement gaps rather than specific policy changes affecting Medicaid programs. While youth nicotine addiction can lead to long-term health consequences that may increase Medicaid costs, this op-ed does not address managed care operations, coverage policies, or state program administration. The piece represents political commentary on federal tobacco regulation rather than actionable guidance for Medicaid plans.
- Industry
KFF Analysis: Medicare Beneficiaries Face Affordability Challenges Across Coverage Types
A KFF brief examines health care affordability for Medicare beneficiaries, including younger adults with long-term disabilities. The analysis draws on multiple data sources to document out-of-pocket costs, premium burdens, and financial strain across traditional Medicare and Medicare Advantage populations. While not directly about Medicaid, the findings are relevant for dual-eligible special needs plans (D-SNPs) and state programs serving Medicare-Medicaid enrollees. Plans serving dual eligibles should consider how Medicare cost-sharing affects their members' total cost of care and care-seeking behavior.
- 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.
- Industry
MACPAC Awards 10-Year Research Contracts to Five Firms for Medicaid Analysis
The Medicaid and CHIP Payment and Access Commission awarded indefinite delivery indefinite quantity contracts to five research firms—Abt Global, Acumen, American Institutes for Research, Altarum Institute, and one additional organization—covering fiscal years 2026 through 2035. These contractors will provide analytic support, data analysis, and policy research to inform MACPAC's congressional recommendations on Medicaid and CHIP. The awards position these firms as primary sources of evidence and analysis that will shape federal Medicaid policy recommendations over the next decade, including managed care delivery system design and payment policy.
- Industry
MACPAC Awards 10-Year Survey Data Contract to University of Minnesota SHADAC
The Medicaid and CHIP Payment and Access Commission awarded a decade-long indefinite delivery indefinite quantity contract for survey data analysis to the State Health Access Data Assistance Center at the University of Minnesota. The contract runs from fiscal years 2026 through 2035 and will support MACPAC's congressional reporting on Medicaid and CHIP access and enrollment trends. This contract supports the data infrastructure behind MACPAC's annual reports to Congress that influence federal managed care policy and payment methodologies.
- 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.
- Industry
MACPAC Seeks Contractor for Survey Data Analysis Task Order Contract
The Medicaid and CHIP Payment and Access Commission (MACPAC) has issued a request for proposals for an indefinite delivery indefinite quantity (IDIQ) task order contract focused on survey data analysis and technical assistance. The RFP is available on www.sam.gov. MACPAC is an independent legislative branch agency that advises Congress on Medicaid and CHIP policy. This procurement supports MACPAC's ongoing work analyzing access, quality, and payment issues in Medicaid managed care and fee-for-service programs.
- Industry
MACPAC Seeks Contractors for Multi-Award IDIQ Contract Under NAICS 541720
The Medicaid and CHIP Payment and Access Commission has issued a solicitation for a multiple-award Indefinite Delivery Indefinite Quantity contract. The request for proposal is available on SAM.gov under NAICS code 541720 (Research and Development in the Social Sciences and Humanities). This procurement may signal MACPAC's research priorities for analyzing Medicaid managed care policy, payment methodologies, and access issues. Firms providing Medicaid research and technical assistance should review the solicitation details on SAM.gov for submission requirements and deadlines.
- Managed Care
MACPAC Urges Managed Care Transparency Reforms, HCBS Access Improvements in March Report
The Medicaid and CHIP Payment and Access Commission released its March 2025 report recommending improvements to external quality review processes in Medicaid managed care, enhanced access to home- and community-based services, and reduced administrative burdens for states and CMS. The recommendations target managed care transparency and accountability mechanisms that directly affect MCO operations and oversight. MACPAC reports to Congress typically influence future CMS rulemaking and state policy decisions. Managed care organizations should review the full report for potential operational and compliance implications.
- State Policy
Federal SNAP Changes Trigger Child Eligibility Losses in Multiple States
New federal legislation (H.R. 1) has resulted in a sharp decline in the number of children receiving SNAP food assistance, despite children not being an explicit target of the policy changes. The law has created cost shifts and access barriers at the state level that are reducing participation among low-income children. The changes affect dual-eligible families who often qualify for both SNAP and Medicaid, creating potential coordination issues for managed care organizations serving mothers and children. States must navigate new administrative requirements that may complicate enrollment processes for families receiving multiple benefits.
- State Policy
State Implementation Timeline for H.R. 1 Medicaid Work Requirements and Eligibility Changes
States are implementing eligibility changes mandated by H.R. 1, including work requirements for Medicaid beneficiaries, immigration-related funding restrictions, elimination of retroactive coverage, and transition to six-month renewals for certain populations. The resource provides key implementation dates as states operationalize these federal policy changes. Managed care organizations should prepare for enrollment volatility, increased disenrollment, and potential changes to capitation rates as states comply with these new requirements. MCOs will need to coordinate with states on member outreach, data reporting for work requirement verification, and network adequacy planning for smaller enrolled populations.
- Industry
CBPP Warns Trump Administration Budget Actions Threaten Medicaid, Safety Net Funding
The Center on Budget and Policy Priorities released multiple analyses warning that Trump Administration actions to block or redirect federal appropriations could disrupt Medicaid and other safety net programs. CBPP researchers called for Congressional appropriations guardrails in 2027 bills to prevent executive interference with enacted funding levels. The organization also flagged House legislation that would make it easier to withhold federal funds from states and programs. These budget control efforts could affect Medicaid managed care organizations through delayed capitation payments, withheld administrative funding, or disrupted federal match for state programs.
- State Policy
House Bill Would Expand Federal Authority to Block Safety Net Program Funding
Proposed federal legislation would make it easier for the administration to block funding for programs including Medicaid, SNAP, and housing assistance. The bill affects state-administered programs where states rely on federal matching funds and federal payment systems. Critics argue the measure could disrupt payments to eligible beneficiaries under the guise of fraud prevention, potentially affecting Medicaid managed care capitation payments and beneficiary enrollment. The timing and specific legislative text remain unclear from this excerpt.
- 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.