CMS to Require States to Revalidate Medicaid Providers

Plans are underway for states to conduct Medicaid provider revalidation, with a focus on identifying inactive, unresponsive, or potentially illegitimate providers, particularly in high-risk categories. States would have 30 days to submit plans outlining how they will carry out these reviews, as previewed by CMS Administrator Mehmet Oz, MD. Dr. Oz pointed to significant gaps in provider enrollment data, including examples where roughly 5,000 providers are listed but fewer than 20% can be verified as responsive or active. He also indicated that CMS has already linked program integrity concerns to funding actions in some states, including signaling up to $2B in potential withholding. As a result, state responsiveness is expected to shape future federal enforcement, with additional audits and funding pressure likely to be directed toward states that do not demonstrate meaningful progress (Fierce Healthcare, April 21).

Erica Schwartz Nominated to be New CDC Director

Erica Schwartz is the new nominee to be the director of the Centers for Disease Control and Prevention. Schwartz served as deputy surgeon general during the first Trump administration and participated in the country’s initial response to the COVID-19 pandemic.  Schwartz will need to be confirmed by the Senate before taking the position at the agency.  Dr. Jay Bhattacharya was acting director of the CDC until March, time-limited in his position to 210 days by the Vacancies Act (CNBC, April 16).

United States of Care Launches Multistate Effort on Cost Containment Policies

A multistate initiative led by United States of Care is bringing together six conservative-leaning states to align on strategies to address healthcare costs. The effort emphasizes policy areas such as price transparency, oversight of provider consolidation, and greater accountability for hospital systems, along with increased ownership transparency and limits on corporate influence in care delivery. The initiative reflects continued pressure on Republican policymakers to respond to affordability concerns, which remain a leading issue for voters. It also signals interest in policy approaches that may gain bipartisan traction at the state level (Inside Healthy Policy, April 17).

CMS Tests Outcome-Based Payments for Digital Chronic Care

CMS is taking the next step toward rolling out its 10-year payment model, the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, focused on managing chronic conditions through digital tools. More than 150 organizations have been conditionally approved to participate ahead of a mid-2026 launch, with additional cohorts expected over time. Under the model, participants will receive a monthly payment for managing Medicare beneficiaries with chronic conditions, with full reimbursement tied to demonstrated clinical improvement, such as reductions in blood pressure. Payment levels are relatively modest, reinforcing a focus on scalable, technology-enabled care. The participant pool includes both providers and digital health companies, many of which are new to Medicare and will need to meet program requirements before fully launching. Applications remain open, with opportunities for additional organizations to join later cohorts. Together, the model aims to address longstanding reimbursement challenges for digital health and reflects continued federal focus on chronic disease management as a key cost and quality priority (Healthcare Dive, April 14).

HHS Secretary Appears Before House Committees

On April 16, HHS Secretary Robert F. Kennedy Jr, appeared before the House Ways and Means Committee to discuss the Trump Administration’s proposed budget cuts to HHS, the Make America Healthy Again agenda, and actions thus far as HHS Secretary. Included in the President’s FY2027 proposed budget is a $16B budget cut for the HHS, a 12.5% budget decrease from the prior year. Many legislators took the opportunity to ask the Secretary about his policy priorities, including his anti-vaccination and autism stances. Secretary Kennedy also appeared last week before the House Appropriations subcommittee on Labor, Health and Human Services, Education, and Related Agencies; topics discussed included HHS agency staffing as well as the administration’s actions on mercury pollution and herbicide glyphosate (NPR, April 16).