ACA
- CMS Cancels 760,000 Enrollments – CMS announced it is cancelling about 760,000 individuals in the ACA Marketplace over alleged unauthorized enrollments. The enrollees cancelled were only located in states that HHS operate. CMS announced it would examine into cancelling additional enrollments.
- Agent/Broker Moratorium – CMS also announced that it would be imposing a moratorium on new brokers or agents signing up enrollees in HealthCare.gov states, at least through open enrollment.
Medicaid
- GENEROUS Model – CMS announced that all 50 states, DC., and Puerto Rico applied to participate in its five-year GENEROUS Medicaid drug-pricing model. Under the model, participating manufacturers provide supplemental rebates designed to bring Medicaid net prices for selected drugs closer to prices paid in certain other developed countries. CMS estimates the model could save $64.3 billion over 10 years.
- New Work Requirements Lawsuit – A new lawsuit was filed over CMS’ definition of the medically frail exemption to the Medicaid work requirements. The plaintiffs seek to halt the implementation of the work requirements. This lawsuit is in addition to another over the medically frail definition. Both cases could result in a halt in implementing work requirements, which are due to take effect next year.
Medicare
- Oz on Medicare Advantage – CMS Administrator Mehmet Oz’s comments on the Medicare Advantage program raised eyebrows after he compared Medicare Advantage to a garden “vulnerable to weeds and overgrowth.” Some observers interpreted the remarks as a signal that CMS would continue focusing on MA costs and coding practices.
- CMS Announces New Laboratory Services Payment Rates – CMS proposed reducing payment rates to better align the 2027 clinical laboratory fee schedule rates with private-sector payment rates, saving an estimated $1 billion annually.
