Healthcare CEOs Testify Before House Ways and Means Committee

Healthcare CEOs convened at the House Ways and Means Committee hearing on April 28 to discuss rising healthcare costs and potential policy options with lawmakers. The CEOs of HCA Healthcare, CommonSpirit Health, and ECU Health were called to testify during this session. Notably, the leaders of these systems indicated that they may be receptive to some site-neutral payment policy in Medicare. This is a large shift from previous efforts from the hospital industry, where previous efforts by Congress to create site-neutral payment policy saw significant pushback. Other topics brought forth by lawmakers included provider consolidation and the 340B drug pricing program. Healthcare CEOs also had suggestions for new policies to reduce hospital costs, which included reducing administrative and regulatory burdens, increasing hospital competition by restricting Certificate of Need Laws, and increasing healthcare coverage (Fierce Healthcare, April 28).

Texas Medicaid Could See CMS Review of Hospice Providers, DME Moratorium According to Dr. Oz

On Tuesday, April 28, Dr. Oz indicated that CMS would turn to Texas to review potential fraud among hospice providers in the state. This follows the agency’s review of hospice fraud in the Los Angeles area. The CMS administrator also noted that Nevada has seen a sizable jump in hospice provider enrollment and highlighted that Nevada, like Florida, has issued a moratorium on new durable medical equipment suppliers. During his message at the Paragon Health Institute event, Dr. Oz suggested that other states may follow Florida and Nevada’s lead by issuing moratoriums on DME provider enrollment. CMS has already issued a national six-month moratorium on DME provider enrollment in Medicare (Inside Health Policy, April 28).

Insurers Tout Efforts to Standardize Prior Authorization Requirements

Following a pledge by 50 insurers to reform prior authorization last year, several insurance companies, including Centene, Cigna, Humana, UnitedHealthcare, and Aetna, announced their voluntary efforts to standardize prior authorization requirements across commercial, Medicare Advantage, and Medicaid lines of business. The insurers state that they have reduced prior authorizations for a variety of healthcare services by about 11% across the board. Industry leaders expect widespread adoption of these voluntary prior authorization standards among additional payers by January 2027 (AHIP, April 24; Modern Healthcare, April 24; Fierce Healthcare, April 24).

CMS Medicaid and CHIP Roadmap Signals State System Changes

As Medicaid and CHIP policy requirements continue to expand through new federal statutes, regulations, and technical guidance, CMS developed the Medicaid and CHIP Policy Implementation Roadmap to help State Medicaid Agencies anticipate how these evolving requirements may affect state policy, operations, and Medicaid Enterprise Systems. Designed as a multi-year planning resource, the roadmap provides an illustrative timeline of selected provisions from major final rules and statutes between 2025 and 2030 that are most likely to create operational or technology-related impacts. CMS emphasizes that the roadmap is not a comprehensive list of every requirement, but rather a strategic reference tool to support proactive implementation planning while states continue to rely on final rules and statutes as the official compliance standard.

The roadmap highlights a phased policy transformation over several years. Early implementation priorities in 2025 and 2026 focus on foundational system and compliance changes such as provider directory standards, access and managed care transparency requirements, quality reporting, beneficiary communication updates, eligibility process reforms, and provisions tied to the Consolidated Appropriations Act and Working Families Tax Cut legislation.

Beginning in 2027, CMS places greater emphasis on person-centered service planning, continuous quality improvement, interoperability, prior authorization transparency, and stronger incident management systems. By 2028 through 2030, implementation priorities increasingly center on Home and Community-Based Services (HCBS), including HCBS quality measure sets, payment adequacy standards, public quality ratings, and expanded electronic oversight systems. Together, these milestones reflect CMS’s push for stronger transparency, modernized systems, quality oversight, and beneficiary protections, requiring states to treat compliance as an ongoing operational priority rather than a one-time policy update (Medicaid, April).

CMS Releases Proposed 2028 HCBS Quality Measure Set

On April 28, CMS published the proposed 2028 Medicaid Home and Community-Based Services (HCBS) Quality Measure Set rule in the Federal Register. The agency is seeking input whether to include 23 mandatory measures in the 2028 HCBS Quality Measure Set. Each state would be required to report on four to five participant-reported measures from each applicable section of the care survey selected by the state; two assessment/case management system measures; and three administrative data measures, all based on the different HCBS populations a state may serve. CMS also proposes that states have the option for CMS to conduct analyses and report on the three administrative measures on the state’s behalf using T-MSIS data. CMS proposes a graduated timeline for states to provide stratified data, including rural and urban status, beginning with 25% of measures in 2028 and ending with 100% of measures, including stratified data, by 2032. The agency is seeking comment on whether the required stratification is feasible and would not cause undue burden or cost. Finally, CMS is soliciting comments on whether to establish a state reporting window, similar to the Adult Core Set, that would open on September 1, 2028, and close on December 31, 2028, or if an alternate schedule is preferred (Federal Register, April 27).