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Friday, October 2 · 12 stories
- Federal Policy
CMS Finalizes Major Updates to Medicare TAVR Coverage Rules
CMS issued a Decision Memorandum on September 10, 2026, finalizing a reconsideration of the National Coverage Determination for Transcatheter Aortic Valve Replacement, prompted by a request from device manufacturer Edwards Lifesciences. The updated NCD relaxes the 2019 rules by allowing asynchronous heart-team patient evaluations, eliminating the requirement for two operators from different specialties, replacing hospital-level volume requirements with operator-level thresholds (20 valve procedures annually, 15 of which must be TAVR), and ending coverage-with-evidence-development requirements for symptomatic severe aortic stenosis. CMS also created a new coverage pathway for asymptomatic severe aortic stenosis, limited to CMS-approved studies. Hospitals and physicians performing TAVR must comply with the revised conditions of Medicare payment, as noncompliance can trigger False Claims Act exposure.
- Federal Policy
Analysis: Medicare Part D Plan Premiums Vary Widely for 2027
A new analysis of the 2027 Medicare Part D stand-alone prescription drug plan (PDP) market finds a modest reduction in the number of available plans alongside uneven premium changes. Many enrollees will see monthly premium increases of less than $10, but others face increases of $50 or more if they remain in their current plan rather than switching during open enrollment. The brief highlights that passive enrollees, those who don't actively shop plans each year, are most at risk of steep cost increases. This affects the millions of Medicare beneficiaries who rely on stand-alone PDPs for drug coverage, distinct from Medicare Advantage drug plans.
- Federal Policy
CDC Proposal Would Cut Disability Questions From Health Survey
CDC has proposed a major redesign of its National Health Interview Survey, set to take effect in 2028, shifting from in-person interviews to a "sequential mixed-mode" approach with shorter, simplified questionnaires. Many detailed topics fielded annually would be dropped, including a question asking whether a physician diagnosed the respondent with an intellectual or developmental disability or autism; only "foundational measures" based on the Washington Group Short Set on functional status would remain. Disability advocates, including The Arc's CEO Katy Neas, warn the change could worsen undercounting of people with disabilities and disrupt longitudinal tracking of disability prevalence, health outcomes, and funding decisions. The proposal, dated Aug. 20, is open for public comment until Oct. 19.
- Federal Policy · SD
CMS Awards $7.2 Million for South Dakota Ambulance Telemedicine
CMS announced $7.2 million in federal funding to expand ambulance-based telemedicine and upgrade emergency communications infrastructure across South Dakota. The funding will support rural emergency medical services, including equipment for real-time video consultation between ambulance crews and physicians during transport. South Dakota officials and providers will implement the upgrades, which aim to improve emergency care access in rural and underserved areas of the state. The announcement did not specify an implementation timeline or the funding mechanism involved.
- Federal Policy
HHS Picks 8 Communities for $96M Homelessness, Addiction Program
HHS Secretary Robert F. Kennedy Jr. announced in Houston that eight communities have been selected to receive funding through the new STREETS program, administered by SAMHSA. The program will distribute $96 million over four years to help selected communities build coordinated systems of care for people experiencing homelessness who have serious mental illness, substance use disorders, or co-occurring disorders. The announcement names the funding recipients but does not detail specific program start dates or application requirements for future rounds.
- Federal Policy
Explainer Chapter Covers Medicare Eligibility, Coverage, and Financing
A Health Policy 101 educational chapter provides a primer on Medicare, the federal health insurance program covering more than 68 million people age 65 and older or with long-term disabilities. It walks through eligibility rules, covered benefits, and program spending, and reviews the growing role of private Medicare Advantage plans in delivering benefits. The chapter also discusses financing challenges driven by rising health care costs and an aging population. No new policy action or data release is reported; this is background reference material rather than a report on a specific event.
- Federal Policy
CMS Opens 340B Part D Claims Data Repository for Voluntary Use
CMS launched its 340B Part D claims data repository on October 1, allowing covered entities and third-party administrators to begin submitting claims data voluntarily. CMS has proposed requiring mandatory submissions starting January 1, 2027. To support entities during the transition, CMS has published a user guide, companion guide, fact sheet, and FAQ. The repository is intended to improve tracking of 340B drug claims under Medicare Part D.
- Federal Policy
CMS Finalizes GLOBE Model Testing International Drug Rebate Benchmark
CMS finalized its Global Benchmark for Efficient Drug Pricing (GLOBE) Model on Sept. 30, a mandatory test of an alternative manufacturer rebate calculation under the Medicare Part B Inflation Rebate Program. Instead of the current domestic pricing benchmark, the model uses a benchmark derived from international pricing data. After public comment, CMS excluded biosimilars, orphan-only drugs, plasma-derived products and certain cell and gene therapies, and carved out manufacturers already participating in its GENEROUS Model, leaving only four manufacturers expected to be required to participate. The model will apply to Medicare beneficiaries in a randomly selected subset of geographic areas covering about 25% of Original Medicare beneficiaries. CMS now estimates $440 million in savings over the seven-year performance period, sharply lower than its earlier $12 billion projection.
- Federal Policy
Georgetown CCF Submits Comments on Senate Finance RFI on Health Coverage
Georgetown University's Center for Children and Families (CCF) submitted comments responding to a Request for Information from Senate Finance Committee Ranking Member Ron Wyden on policy proposals to improve access, quality, and affordability of health coverage nationally. The RFI sought stakeholder input on a broad range of proposals affecting health coverage, including Medicaid and CHIP. CCF's submission reflects the organization's positions on how these proposals would affect children's and families' coverage. The specific policy recommendations and their implications for state Medicaid programs are detailed in CCF's full submission.
- Federal Policy · OH
Census Bureau Delays Poverty Data Amid Medicaid, SNAP Cuts
The Census Bureau has indefinitely delayed its American Community Survey, a key dataset tracking state and local poverty, income, insurance and housing trends, just as deep federal safety-net cuts take hold. The bureau attributes the delay to a new Commerce Department order banning "noise infusion," a privacy-protection technique, though some scientists quoted in Science magazine suspect political motives. Researchers say the gap leaves them unable to measure the state-level impact of the One Big Beautiful Bill Act's roughly $1 trillion in Medicaid cuts and $187 billion in SNAP cuts, plus the expiration of ACA subsidies that caused Ohio's Medicaid-adjacent marketplace enrollment to drop 32.4%, the largest decline of any state. No new release date has been set.
- Federal Policy
Refugees, Asylum Seekers Lose Medicaid Eligibility Under H.R. 1
Starting October 1, refugees and asylum seekers nationwide are losing access to Medicaid due to eligibility restrictions enacted in H.R. 1, the Trump administration's budget law passed by congressional Republicans in summer 2025. The change removes a previously available coverage pathway for these immigrant populations, affecting their ability to access health services through Medicaid. States and Medicaid managed care plans must now determine how to handle enrollees who lose eligibility under the new rules. The cutoff is effective immediately as of October 1, 2026.
- Federal Policy · OR
Five Governors Press HHS to Delay Jan. 1 Medicaid Work Rules
Oregon Gov. Tina Kotek led governors from California, Maine, New York and Virginia in a letter urging HHS Secretary Robert F. Kennedy Jr. to delay the Jan. 1 effective date for new Medicaid work-requirement and eligibility rules stemming from the 2025 federal tax and spending law. The governors say final federal rules, issued six months after initial January guidance, contradicted that earlier guidance and changed the medical frailty definition, forcing states to rebuild eligibility systems, forms and verification processes with less than 100 days to spare. This is their second such request after a May 29 letter went unanswered by HHS. The governors cite CBO estimates that the new work-reporting requirements could leave 5 million people uninsured by 2034, with roughly half of coverage losses driven by paperwork and reporting errors rather than ineligibility.
Thursday, October 1 · 10 stories
- Federal Policy
CMS Offers Hospices Three-Month Grace Period on Addendum Rule
Hospices are now required to give every patient an addendum to the election statement explaining what is and isn't covered under the Medicare Hospice Benefit, a requirement that took effect October 1, 2026 under the FY2027 hospice payment rule. Previously, hospices only had to provide the addendum upon request. CMS announced it will exercise enforcement discretion through December 31, 2026, during which Medicare Administrative Contractors will not deny claims solely for a missing or incomplete addendum, instead focusing on provider education. After that date, hospices that fail to comply face claim denials and increased regulatory scrutiny. Advocacy group NPHI has raised concerns that the mandate creates undue administrative burden with limited patient benefit.
- Federal Policy
States Face Higher SNAP Costs as New Cost-Share Rule Starts
Beginning Thursday, states must cover 75% of SNAP administrative costs, up from the historical 50-50 federal-state split, as federal funding for those operational costs is cut in half. The change stems from the One Big Beautiful Bill Act, enacted in July 2025, and is projected to reduce federal SNAP spending by $16.9 billion over five years. Advocacy groups estimate individual states could need $3 million to $670 million to fully offset the loss, with California, New York, Pennsylvania, Texas and Michigan hit hardest. A second change looms in October 2027, when states with SNAP payment error rates at or above 6% may have to start paying a share of food benefit costs themselves, a shift analysts warn could push some states toward program cuts or withdrawal.
- Federal Policy
HRSA Names Manufacturers Approved for Expanded 340B Rebate Pilot
HRSA has disclosed which drug manufacturers are approved to participate in a revised 340B rebate pilot, under which ten drugmakers will shift 21 drugs from upfront discounts to after-the-fact rebate payments starting next year. The change expands on the administration's earlier rebate pilot attempt. Covered entities purchasing these drugs through 340B will need to pay full price at the point of sale and later seek rebates, rather than receiving discounts immediately. The shift takes effect at the start of next year.
- Federal Policy · AL
CMS Awards Nearly $55 Million for Rural Maternal, Emergency Care
CMS announced nearly $55 million in new federal funding to expand rural maternal health services, emergency care, cancer screening, and healthcare workforce development, with a specific focus on Alabama's rural healthcare workforce. The funding is aimed at rural hospitals and providers facing access gaps in obstetric and emergency services. The announcement does not specify the exact award mechanism or full list of recipient states beyond Alabama's workforce component. Rural Medicaid beneficiaries, who rely heavily on these facilities for maternal and emergency services, stand to benefit from expanded capacity and workforce investment.
- Federal Policy
CMS Finalizes International Reference Pricing Model for Part B Drugs
CMS finalized the GLOBE Model, a mandatory payment model tying Medicare Part B drug inflation rebates to prices paid in 19 reference countries, per a Sept. 30 CMS news release. The regulation takes effect Nov. 30, with voluntary manufacturer data submission beginning Jan. 1, 2027, a five-year performance period from April 2027 through March 2032, and a seven-year payment period running through March 2034. The final model is narrower than proposed, excluding orphan-only drugs, biosimilars, plasma-derived products and certain cell and gene therapies, cutting projected Medicare Part B savings from $8.4 billion to $440 million over the payment period. GLOBE applies to a random sample of ZIP code areas covering about 25% of Original Medicare Part B beneficiaries and follows the Medicaid-focused GENEROUS model, under which 40 states and Puerto Rico have already agreed to similar international benchmarking for Medicaid drug pricing.
- Federal Policy
CMS Updates MDS Coding Guidance, Discharge Rules Still Unclear
CMS has issued updates to the MDS 3.0 Resident Assessment Instrument manual that address a long-standing provider concern: documentation demands during state case-mix audits and medical reviews that are often additional or conflicting. Nursing home operators and industry observers describe the coding changes as a significant win for providers, though questions remain around discharge coding clarity. The updates are due to be implemented, though the source does not specify a firm effective date. Nursing facilities, Medicaid case-mix states, and auditors handling MDS-based reviews will need to adjust documentation and audit practices once the guidance takes effect.
- Federal Policy
CMS Finalizes Scaled-Back Medicare Drug Pricing Pilot
The Trump administration finalized the GLOBE rule, a mandatory pilot aimed at lowering Medicare prices for physician-administered drugs by benchmarking them to prices in other wealthy countries. The final version applies to only four drug companies, a steep reduction from the scope of the initial proposal, and excludes companies that already struck voluntary most-favored-nation pricing deals covering Medicaid drugs. A related mandatory pilot, GUARD, remains at the proposed-rule stage. The narrowed scope significantly limits projected savings compared to the original proposal.
- Federal Policy
Trump Public Charge Rule Revival Sparks Multistate Lawsuit
The Trump administration revived a first-term policy letting immigration agents deny green cards or visas to applicants whose families use public benefits, effective September 18. The rule broadens eligibility factors beyond the Clinton-era standard and could count benefits used by family members, including children's Medicaid and SNAP enrollment, against immigrant applicants. Twenty-one Democratic-led states, D.C., and several major cities have sued, citing the administration's own estimates of "catastrophic" impacts on immigrant families. Advocates expect a chilling effect causing eligible U.S.-citizen children in immigrant households to be disenrolled from Medicaid and SNAP out of fear, even though most legal immigrants already don't qualify for these programs.
