Sellers Dorsey Digest

Federal Updates

News

POTUS Names His Nominee for CDC Head

• On March 24, President Donald Trump nominated Susan Monarez, who is currently serving as acting director of the CDC, to be the agency’s permanent director. Before taking up this post, Monarez served as the deputy director of Advanced Research Projects Agency for Health (ARPA-H), a federal agency that funds innovative biomedical research. She has also held former leadership positions at the Department of Homeland Security and served on the National Security Council and the White House’s Office of Science and Technology Policy (Washington Post, March 24; Modern Healthcare, March 24).

New Chair and Vice Chair Appointed to USPSTF Amid Uncertainty Over the Task Force

• The United States Preventive Services Task Force (USPSTF) has appointed Michael Silverstein as the new chair and Esa Davis as vice chair. Silverstein specializes in mental health for children and families, working as the Director of Brown University’s Hassenfield Child Health Innovation Institute while Davis’s research at the University of Maryland School of Medicine includes maternal obesity and tobacco use disorder interventions. Additionally, one member of the USPSTF’s four-year term expires this year, leaving one nomination available. That nomination must be made by the HHS Secretary. While the Trump Administration has decided to continue the defense of the USPSTF in a Supreme Court case challenging the task force’s authority, how the Administration plans to utilize the task force going forward is unclear. Under the Affordable Care Act, insurers are currently required to cover all services with an A or B grade recommendation from the USPSTF (Inside Health Policy, March 24).

MACPAC’s 2025 Recommendations: Improving Medicaid Oversight, Access, and Efficiency

• MACPAC’s March 2025 Report to Congress focuses on improving Medicaid by making oversight clearer, access easier, and administration more efficient. First, it recommends improving the managed care external quality review (EQR) process, which helps ensure that 73% of Medicaid beneficiaries in managed care receive high-quality care. By making EQR findings more transparent and useful, states and managed care organizations (MCOs) can be held more accountable, ultimately benefiting enrollees. Second, the report addresses delays in accessing home-and community-based services (HCBS), which help people with long-term care needs stay in their homes and communities. MACPAC recommends clearer federal guidance on provisional care plans and ways to speed up eligibility, particularly for those who don’t qualify under traditional income rules. Finally, MACPAC suggests easing administrative burdens by extending the renewal period for HCBS programs from five to ten years. This would give states more stability while reducing paperwork, allowing them to focus on delivering care rather than navigating bureaucracy (MACPAC.gov, March 13).

Federal Regulation and Guidance

Buprenorphine and Veterans’ Telemedicine Final Rule Effective Dates Bumped to December

• In a notice published in the Federal Register on March 24, the Department of Health and Human Services and Drug Enforcement Administration pushed back the effective dates for the buprenorphine and veterans’ telemedicine final rules from March 21 to December 31. However, the delay maintains pandemic-era flexible telehealth prescribing rules for controlled substances to avoid disruptions to care. The Department of Justice will use the additional time to review the legal and policy implications of the pending final rules. The buprenorphine rule would allow for a six-month supply of medicine via telehealth, including audio-only services, with requirements to transition to in-person or audio-visual telehealth. The veterans’ final rule would allow this population to receive schedule II-V controlled substances via telehealth as long as they had previously seen a provider with the United States Department of Veteran Affairs in person. The broader telehealth prescribing flexibilities expire at the end of the year (Inside Health Policy, March 21; Federal Register, March 24).

State Updates

News

Minnesota Health System Leaders Discuss Potential Federal Medicaid Cuts

• Leaders at Hennepin Healthcare are raising concerns about the potential impact of proposed cuts to federal Medicaid funding, worried that it will lead to more patients with preventable conditions presenting at the emergency room (ER). Democratic Representatives Ilhan Omar and Kelly Morrison, along with healthcare leaders and patients, gathered in Minneapolis to discuss the possible impact of these cuts. In Minnesota, one in five people rely on Medicaid, and at Hennepin Healthcare, 62% of ER patients are covered by Medicaid. If the federal government reduces funding, Minnesota may face difficult choices, either spending more state money to maintain services or cutting back (Minnesota Reformer, March 20).

Indiana Medicaid Expansion Bill Sparks Debate

• An Indiana House of Representatives committee recently passed Senate Bill 2 after removing a provision in the bill that would have placed a cap on enrollment in the state’s Medicaid expansion program, known as the Healthy Indiana Plan (HIP), to 500,000 people. The revised bill would instead allow the Family and Social Services Administration to stop enrolling people once the state’s budget for the program is depleted. The bill also includes work requirements, mandating 20 hours of work per week for HIP enrollees, with exceptions for caregiving, disability, and education. While supporters argue the changes are necessary to control rising Medicaid costs, critics, including health experts, worry that adding more paperwork and eligibility checks will create confusion and additional costs without helping those who truly need care (Indiana Capital Chronicle, March 19).

SPA and Waiver Approvals

Waivers

• 1115(a)
  • North Carolina
    • On March 25, CMS approved North Carolina’s request for a new public health emergency (PHE) 1115 waiver titled, “North Carolina Hurricane Helene Public Health Emergency Section 1115(a) Demonstration.” The state receives authority to provide retainer payments to 1905(a) personal care providers as a source of relief for damages suffered by the hurricane impacting their ability to provide Medicaid services. The approval also grants the state authority to provide Healthy Opportunity Pilot (HOP) services for beneficiaries who initially resided and were approved for services in the affected HOP region on the day that the PHE began, September 25, 2024, but have since been displaced. This demonstration is effective retroactively to September 25, 2024, and continues through March 23, 2025, the final date of the PHE.

SPAs

• Administrative
  • Iowa (IA-24-0017, effective December 1, 2024): Provides for assurances with the federally mandated quality reporting requirements outlined in the Child Core set and behavioral measures on the Adult Core Set.
• Payment
  • Florida (FL-24-0013, effective October 1, 2024): Updates the payment methodology for Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC).
  • Maine (ME-24-0005, effective January 1, 2024): Updates the payment methodology for targeted case management services.
  • Maine (ME-24-0035, effective December 31, 2024): Updates the payment methodology for certain home health supplies by removing language relating to annual cost-of-living adjustments (COLA).
  • Maine (ME-23-0012, effective January 1, 2023): Updates the payment methodology for Targeted Case Management (TCM) and rehabilitative services.
  • Maine (ME-24-0030-B, effective November 15, 2024): Updates the outpatient supplemental payment pool amounts made to non-critical access hospitals.
  • Massachusetts (MA-24-0041, effective November 7, 2024): Establishes eligibility and supplemental payment methodologies for mental health centers.
  • New Jersey (NJ-24-0026, effective October 1, 2024): Updates the payment methodology for Covid-19 vaccine administration and testing.
  • New York (NY-24-0074, effective October 1, 2024): Updates the payment methodology for covered outpatient drugs, prescribed drugs, and physician administered drugs (PAD).
• Services
  • American Samoa (AS-24-0002, effective October 1, 2024): Provides for coverage and payment of orthodontic services to the list of dental services covered under the ESPDT benefit for patients under 21.
  • Louisiana (LA-24-0017, effective October 20, 2024): Amends coverage provisions for the administration and distribution of non-emergency medical transportation (NEMT) Elevated Levels of Care (ELOC) services by NEMT vendors and clarifies language for Non-Emergency Medical Ambulance Transportation (NEAT).

Private Sector Updates

News

UnitedHealth’s Drug Benefits Unit to Reimburse Name-Brand Prescriptions at Higher Rates

• Following CVS and Express Scripts, which have led the way with reimbursement modifications, UnitedHealth Group Inc’s OptumRx announced that it will begin adjusting reimbursement rates to pharmacies that are selling more brand-name medications. In the past, PBMs awarded higher reimbursement for the usage of generic drugs, causing pharmacies to discontinue stocking of branded drugs and limiting access to newer items such as diabetes and weight-loss drugs. OptumRx has already begun making these changes and hopes all name-brand prescriptions will be re-valued by 2028 (Modern Healthcare, March 20).

Johnson & Johnson Unveils Plans to Invest Over $50B in Research, Development, Manufacturing, and Tech

• On March 21, Johnson & Johnson (J&J) announced its intent to invest $55B in technology, manufacturing, research and development over a four-year period. J&J plans to build four drug manufacturing facilities, one of which will focus on the production of cancer, immune disease, and neurological condition medications. This facility is expected to be built in Wilson, North Carolina and boost the state’s economy by $3B in the first decade and bring about 5,000 construction jobs and 500 positions once up and running. J&J will also focus on technology initiatives that will support workforce training and aid in enhancing operations. Focuses of the company’s research and development include oncology, neuroscience, immunology, cardiovascular disease and robotic surgery (Modern Healthcare, March 21).

HCSC Acquires Cigna’s Medicare Business for $3.3B

• Health Care Service Corp. (HCSC) has finalized its $3.3B acquisition of Cigna’s Medicare business, which includes Medicare Advantage, Part D, and Medicare supplement plans, as well as the CareAllies consulting unit. This deal significantly expands HCSC’s Medicare Advantage membership to 800,000 and extends its reach to 25 additional states and the District of Columbia. HCSC, which offers Blue Cross and Blue Shield plans in five states, now has a broader footprint in the Medicare market, gaining access to both the Part D and Medigap markets across the country. For Cigna, this sale marks the end of its Medicare plan business. Although Cigna is stepping back from the Medicare Advantage market, its Evernorth subsidiary will continue to manage pharmacy benefits for the affected Medicare members for the next four years. Cigna has since turned its focus to expanding Evernorth, which includes its specialty pharmacy and Express Scripts pharmacy benefit manager (Modern Healthcare, March 29).

Sellers Dorsey Updates

NEWS

NEW BLOG | The Role of Medicaid in Child Welfare: How Providers Can Bridge Gaps for Better Outcomes

• Providers play a crucial role in supporting children and families in the child welfare system. In her latest blog, Senior Director Katie Renner Olse discusses how collaboration between Medicaid, child welfare agencies, and healthcare professionals can improve outcomes to these vulnerable populations.

Read the blog