CMS Innovation Center Cancels Eight Models Ahead of New Strategy Announcement

April 9, 2025

EGWP medicaid Medicare

The CMS Innovation Center (CMMI) announced on March 12 that certain payment models will be canceled or end by Dec. 31, 2025. The declaration was made after a review of the model portfolio by the Trump administration, which asserts that models must reduce spending in addition to maintaining or improving quality. The Biden administration sought to position improvements in quality that did not increase costs as an appropriate goal as well. The eight impacted models will result in nearly $750 million in savings: Making Care Primary, Primary Care

First, Vermont All Payer ACO, Maryland Total Cost of Care Model, Maternal Opioid Use Model, End-Stage Renal Disease Treatment Choices, Medicare Two Dollar Drug List Model, and Accelerating Clinical Evidence Model. CMMI says it will help participants in the affected models minimize disruption to their operations and the beneficiaries they serve, but did not provide details about what support it may offer.

The agency also plans to announce a new strategy based on “guiding principles to make Americans healthier by preventing disease through evidence-based practices, empowering people with information to make better decisions, and driving choice and competition.” 

legislation

CMS Releases Final 2026 MA Policy and Technical Rule; Declines to Finalize Coverage of GLP-1s

On April 4, the Centers for Medicare & Medicaid Services (CMS) finalized the 2026 MA Policy and Technical Changes rule. Of note, CMS is not finalizing certain provisions from the proposed rule, most importantly the proposal requiring coverage of anti-obesity medications (AOMs) in both Medicare and Medicaid. CMS said that it may address these proposals […]
read more >

April 9, 2025

EGWP marketplace medicaid Medicare

legislation

Budget Reconciliation Process Continues with Senate Consideration of Revised House Resolution

On April 5, the Senate voted 51-48 to pass a modified version of the House-passed budget resolution with reduced deficit reduction targets for Senate committees as compared to the House. Specific to health care, the revised Senate resolution instructs the Senate Finance Committee (SFC), which has jurisdiction over Medicaid, to propose changes that will increase […]
read more >

April 9, 2025

medicaid

legislation

2026 Final Rate Announcement for MA and Final Part D Program Instructions

On April 7, CMS released the Calendar Year (CY) 2026 MA and Part D Final Rate Announcement and the Final CY 2026 Medicare Part D Program Instructions. The Administration strongly defended its focus on fraud, waste, and abuse, while protecting beneficiaries. The final rate notice increases average payments to MA plans by 5.06% up from […]
read more >

April 9, 2025

EGWP medicaid Medicare

You may also like