- Senate introduces Provider Reimbursement Stability Act
- AMA calls on CMS to significantly rework Medicaid work requirements rule to prevent improper disenrollments and administrative burdens on patients and physicians
- New CMS guidance clarifies freeze on several previously finalized marketplace plan changes for 2027 as HHS appeals
- More articles in this issue
Senate introduces Provider Reimbursement Stability Act
On July 30, the Senate introduced S. 5180, the Provider Reimbursement Stability Act, a companion piece of legislation to H.R. 8163 which passed out of the House Ways and Means Committee unanimously earlier this year.
Introduced by Senators Boozman (R-AR), Welch (D-VT), Marshall, MD (R-KS), King (I-ME), Tillis (R-NC) and Shaheen (D-NH), S. 5170 would modernize Medicare's physician fee schedule. In particular, the legislation would:
Increase the budget neutrality threshold from $20 million to $57.64 million and index it to the Medicare Economic Index (MEI) every five years, to address rising practice costs
Revise spending estimates and budget neutrality adjustments based on utilization rates derived from claims data
Provide updates to direct costs used to calculate practice expense relative value units (RVUs), including clinical wage rates, medical supplies and equipment, not less often than every five years
Limit year-to-year positive or negative variances in the conversion factor to no greater than 2.5%
The AMA has been working to see this legislation introduced and is excited to see this bill introduced in the Senate. The AMA will continue to work with sponsors to build support of the legislation and see it across the finish line and enacted into law.
Contact your senators today and urge them to support common sense Medicare payment reforms by cosponsoring this bipartisan bill.
AMA calls on CMS to significantly rework Medicaid work requirements rule to prevent improper disenrollments and administrative burdens on patients and physicians
On July 29, the AMA submitted comments (PDF) on a Centers for Medicare & Medicaid Services (CMS) interim final rule implementing Medicaid community engagement requirements (also known as “work requirements”) enacted by Public Law 119-21, the “One Big Beautiful Bill Act.” The AMA urged CMS to revise the rule and expressed concerns that, as written, the rule will result in many eligible patients losing or being denied Medicaid coverage because they will be unable to navigate the complex administrative process required to demonstrate compliance or obtain an exemption.
Specifically, the AMA’s comments called on CMS to:
Revise the improperly restrictive standards for qualifying for a medical frailty exemption from the work requirements
Give states the time they need to build effective systems to process the unprecedented level of data and functions needed to run a Medicaid work requirements program
Establish stronger beneficiary protections, such as more realistic response times and continued coverage when third-party documentation is pending
The comments emphasize the need to revise the rule’s medical frailty standards, under which patients seeking an exemption must demonstrate not only that they have a qualifying medical condition but also that their condition significantly impairs their ability to comply with work requirements. The addition of this impairment criterion—which is inconsistent with the statutory language underpinning the work requirements—improperly narrows the medical frailty exemption, threatens states’ ability to effectively identify medically frail individuals through automated, ex parte processes, and places enormous burdens on patients and physician practices, who will be required to make impairment determinations without clear clinical standards. Instead, the AMA urged CMS to align with the statutory standards for medical frailty by eliminating the impairment criterion, and to preserve self-attestation when reliable data are unavailable, allow for the use of older records to verify long-term conditions, and avoid repeated reverification for permanent, irreversible or progressive conditions.
The AMA has long opposed work requirements as a condition of Medicaid eligibility and has spoken up many times about potential coverage losses resulting from work requirements. Most recently, the AMA, alongside the Massachusetts Medical Society, filed an amicus brief (PDF) supporting 26 plaintiff states challenging the interim final rule. The AMA will continue to engage with CMS, state Medicaid officials, and other stakeholders to pursue the best possible outcome for patients and physicians as all states must begin implementing Medicaid work requirements no later than Jan. 1, 2027.
For more information on the AMA’s advocacy relating to the cuts enacted by the One Big Beautiful Bill Act, please visit ama-assn.org/ob3.
New CMS guidance clarifies freeze on several previously finalized marketplace plan changes for 2027 as HHS appeals
On July 31, CMS issued a statement (PDF) regarding the June 12 City of Columbus v. Kennedy ruling (PDF) which stayed several noteworthy provisions of the Notice of Benefit and Payment Parameters for 2027 final rule. The following provisions, originally scheduled to take effect on July 20 for plan year 2027, will not go into effect while the case is pending:
The new failure to file and reconcile policy
New income verification policies when existing data sources indicate income less than 100 percent of the federal poverty level
Removal of the requirement to accept attestations of household income when tax data is unavailable
Removal of the restriction on special enrollment period (SEP) verification
The new requirement to verify at least 75% of SEPs
Expansion of maximum out-of-pocket limits for individual market bronze and catastrophic plans
Expansion of eligibility for catastrophic plans
Allowing states to conduct their own provider access and Essential Community Provider reviews
Relaxation of network adequacy standards
Allowing non-network plans to be offered as qualifying health plans
The elimination of certain standardized plans requirements
Revisions to limitations for non-standardized plans
The statement (PDF) also clarifies that open enrollment for plans on the federal exchange will end on Jan. 15, 2027, not Dec. 15, 2026, as originally finalized.
CMS appealed the decision to the Fourth Circuit in mid-July.
