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Health Plan Accountability Update: October 2025
The AHA May 29 submitted a letter to the Centers for Medicare & Medicaid Services responding to a request for information regarding Medicare Advantage data, urging CMS to increase oversight of the program.
AHA encourages MedPAC to refine analysis of MA enrollment impacts on patients, providers
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on hospitals, which found that increased enrollment is not statistically associated, on average, with all-payer hospital margins.
AHA Comments on MedPAC Analysis of MA Enrollment Changes
AHA comments on the Medicare Payment Advisory Commission’s preliminary analysis of the association between Medicare Advantage (MA) enrollment changes and hospital finances shared during the September public meeting.
Senate again fails to pass CR, government shutdown continues
The federal government shutdown will continue as the Senate Oct. 3 failed to adopt a government funding deal. The latest attempt to pass the House-passed continuing resolution failed by a 54-44 vote, while another attempt on a short-term funding bill led by Senate Democrats failed by a 46-52 vote.
CMS finalizes Medicare Part C Utilization Management Annual Data Submission requirements
The Centers for Medicare & Medicaid Services Sept. 30 issued a memo, through the Health Plan Management system, finalizing the Medicare Advantage Utilization Management Annual Data Submission requirements for MA organizations.
Senate fails to pass CR, government shutdown begins while health programs expire
The federal government shut down Oct. 1 following a failed Senate vote on the House-passed continuing resolution to fund the government by midnight Sept. 30.
AHA provides recommendations to HHS, CMS for insurers to adhere to prior authorization pledge
The AHA Sept. 29 sent recommendations to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure insurance plans adhere to the agencies’ health insurer pledge to reform prior authorization processes.
CMS says premiums, enrollment for MA and Part D to slightly decline for 2026
The Centers for Medicare & Medicaid Services announced Sept. 26 that average premiums for Medicare Advantage and Part D would decline slightly in 2026.
AHA Comments on CMS CY 2026 Outpatient, ASC Proposed Payment Rule
RE: CMS–1832–P Medicare and Medicaid Programs; Calendar Year 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
AHA-supported legislation would apply prompt payment standard to MA plans
The AHA expressed support Sept. 22 to House and Senate sponsors of the Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), legislation that would apply a federal prompt payment standard to MA plans to help ensure that health care providers receive timely payments from MA plans for necessary patient services.