- Medicare Trustees warn of unsustainability of Medicare physician payment system
- MedPAC June report highlights future areas of work for Medicare payment reform under new chair
- AMA submits comments urging CMS to strengthen prior authorization timelines, transparency and interoperability requirements
- MACPAC report reflects successful AMA prior authorization reform advocacy
- New AMA patient guide: New Medicaid work and community engagement rules coming in 2027
- New HHS Request for Information focuses on the chronic disease of addiction
- Senate HELP Committee passes AMA-supported legislation
- Registration open for AMPAC Campaign School
- More articles in this issue
Medicare Trustees warn of unsustainability of Medicare physician payment system
The Medicare Trustees released their 2026 report and highlighted concerns about the future of Medicare physician payment updates, as they will be significantly below inflation as measured by the Medicare Economic Index (MEI). With no annual payment update to account for inflation in the costs of medical practice, physicians have seen their payments (when adjusted for inflation in practice costs) decline 33% from 2001 to 2026.
As they have in the past, the Trustees noted that, “[a]bsent a change in the delivery system or level of update by subsequent legislation, the Trustees expect access to Medicare-participating physicians to become a significant issue in the long term.” They also pointed out that Medicare physician payment levels dropped from 82% of private rates in 2011 to 68% in 2024, and if current trends continue, will fall to only 23% of private rates by the end of the Trustees’ 75-year projection period.
This report builds on similar repeated warnings from policymakers and the AMA that long-term access to care for seniors is threatened by Medicare’s failure to keep up with the cost of practicing medicine.
MedPAC June report highlights future areas of work for Medicare payment reform under new chair
On June 15, the Medicare Payment and Advisory Commission (MedPAC) released their June 2026 report. The first chapter (PDF) focuses on improving payment incentives in Medicare, taking a comparative look at Medicare fee-for-service (FFS) relative to Medicare Advantage and Medicare Alternative Payment Models (APMs). While the June report does not include new recommendations, it highlights several areas for future work, including sources of Medicare spending growth, strategies to reduce low-value care, harmonizing payments across settings and service types, reforms to Medicare Advantage methodologies and improvements to APM design. The report also explicitly notes the commission’s ongoing recommendation to increase Medicare physician payment rates “to bring FFS Medicare’s overall payment levels closer in line with provider’s costs,” which the AMA has strongly supported in the past, and which helped contribute to the introduction of the Strengthening Medicare for Patients and Providers Act of 2025 (H.R. 6160), bipartisan legislation that would permanently tie Medicare physician payments to inflation based on the Medicare Economic Index.
Last month, 2026 MedPAC appointments were announced, including a new chair, Amol S. Navathe, MD, PhD, from the University of Pennsylvania. The first meeting of the 2026-2027 MedPAC will take place Sept. 3-4.
AMA submits comments urging CMS to strengthen prior authorization timelines, transparency and interoperability requirements
On June 12, the AMA submitted comments (PDF) to the Centers for Medicare & Medicaid Services (CMS) on its proposed Interoperability Standards and Prior Authorization (PA) for Drugs rule (CMS-0062-P). The proposal would build on the 2024 Interoperability and Prior Authorization final rule (CMS-0057-F) by:
- Extending electronic PA and interoperability requirements to drugs covered under both the medical and pharmacy benefits
- Requiring clearer communications when drug PA requests are denied
- Establishing and aligning certain drug PA decision timeframes
- Expanding PA transparency and oversight through new public reporting, application programing interface (API) usage metrics and interoperability standards
- Adding new reporting metrics for non-drug items and services, including total PA volume and outcomes following appeals and extended reviews
In its comment letter, the AMA supported CMS’ efforts to modernize drug PA while urging the agency to adopt additional reforms to improve transparency, reduce administrative burden, and ensure timely access to care. Specifically, the AMA urged CMS to:
- Strengthen PA decision timelines by requiring 24-hour determinations for all prescription drug PA requests, shortening timelines for non-drug services, and clarifying that only a final approval or denial satisfies a PA deadline.
- Expand and clarify public reporting requirements for drug and non-drug PA by standardizing the format of PA lists and metrics; requiring plan-level, service-level and drug-class-level reporting; requiring numeric counts of PA requests and outcomes in addition to percentages; requiring disclosures to be posted on Medicare Plan Finder and uniform payer website locations; and clarifying that all functionally equivalent utilization management processes must be included in PA reporting.
- Require payers to use uniform denial notices that contain the specific information needed to correct, appeal or otherwise act on a denial, and require those notices to be sent through the same electronic workflow used to submit the request.
- Ensure interoperability requirements reduce administrative burden in practice by requiring payer conformance testing, public reporting of API performance, accurate and timely formulary and benefit information, evidence-based and auditable PA criteria, prohibiting payers from defaulting to online portals, fax or phone calls, and stronger oversight of payer implementation.
- Preserve and improve electronic prescribing standards by continuing to require both Formulary & Benefit and Real-Time Prescription Benefit standards, holding payers accountable for accurate coverage and formulary data, and establishing clear national standards for routing drug PA requests through Fast Healthcare Interoperability Resources and National Council for Prescription Drug Programs-based workflows.
- Prohibit PA and other utilization management barriers for medications to treat opioid use disorder and for initial prescriptions used to treat post-operative or moderate-to-severe acute pain.
The AMA also highlighted new survey data (PDF) demonstrating that PA continues to delay care and burden physician practices. According to the survey, 95% of physicians report that PA delays necessary care, 79% report that it sometimes leads patients to abandon treatment, and 26% report that PA has resulted in a serious adverse event for a patient in their care.
The AMA will continue working with CMS to ensure the final rule delivers on its promise: fewer PA delays, less administrative burden and better outcomes for patients.
MACPAC report reflects successful AMA prior authorization reform advocacy
The Medicaid and CHIP Payment and Access Commission (MACPAC) recently released its June 2026 Report to Congress on Medicaid and CHIP, which includes a chapter (PDF) specifically focusing on use of automation and augmented intelligence (AI) in Medicaid prior authorization (PA). As a result of effective AMA advocacy (including participation in a panel at an April 2025 Public Meeting), the report’s contents and recommendations align with physicians’ PA reform priorities.
Notably, MACPAC’s report recommends that the secretary of the U.S. Department of Health and Human Services direct CMS to issue guidance or amend regulations to require that any adverse medical necessity determinations under either Medicaid fee-for-service or managed care PA programs be made by “an individual with appropriate expertise” in addressing the patient’s medical or behavioral health needs. In addition, MACPAC specifically states that negative PA determinations should “not be made by automation tools alone” and “must be made based on individualized determinations of medical necessity,” regardless of whether the Medicaid plan uses automation or AI tools in issuing the decision. Finally, MACPAC recommends that state Medicaid agencies require managed care plans to disclose use of automation and AI in PA determinations, to include reporting on testing, evaluation and oversight of such tools. MACPAC referenced the AMA’s AI policy principles (PDF) in the report, and its recommendations requiring qualified clinician involvement in adverse PA decisions and improved transparency on payer use of AI show AMA’s successful advocacy in advancing PA reform.
New AMA patient guide: New Medicaid work and community engagement rules coming in 2027
To help patients understand the new Medicaid community engagement requirements, the AMA has developed a concise patient guide (PDF). This resource explains exemptions, compliance requirements, and important steps patients should take to maintain coverage. Physicians and care teams are encouraged to share this guide widely with Medicaid patients to help ensure they are informed and prepared for upcoming changes. The patient guide (PDF) is available on the AMA website alongside additional resources related to One Big Beautiful Bill Act implementation.
New HHS Request for Information focuses on the chronic disease of addiction
The Department of Health and Human Services (HHS) recently issued a Request for Information (RFI) seeking public input on successful research, programs, and policies that improve prevention, treatment, and recovery for addiction, mental illness and co‑occurring disorders. It aims to identify gaps and novel policy ideas to advance the Great American Recovery Initiative using existing funding. Public comments are due to HHS by July 5, 2026.
HHS’s work on the Great American Recovery Initiative is highlighted in President Donald J. Trump’s Executive Order 14379 from January 2026, and Executive Order 14321 from July 2025. It represents HHS’s efforts to strengthen federal guidance and grants to support the nation's recovery, with a focus on prevention, treatment, and long-term resilience.
The RFI specifically asks for comments related to the programs or interventions that have rigorous, empirical evidence of effectiveness in improving outcomes for substance use prevention, treatment and recovery; mental illness prevention, treatment and recovery; and care for co-occurring mental and chronic disease of addiction. It also asks for ideas on changes in policy or existing federal programs that might improve outcomes.
Senate HELP Committee passes AMA-supported legislation
On June 17, the Senate Health, Education, Labor and Pensions (HELP) Committee held a legislative mark-up on several pieces of legislation, including S. 1782, the "Charlotte Woodward Organ Transplant Discrimination Prevention Act," which is supported (PDF) by the AMA. S. 1782 was approved by the committee. The legislation makes great strides toward ending discrimination against individuals with disabilities in the organ transplant system. Policy adopted by the AMA House of Delegates supports the equitable inclusion of people with intellectual and developmental disabilities in eligibility for transplant surgery, and this legislation would directly address these concerns by prohibiting the board of directors of the Organ Procurement and Transplantation Network from issuing policies or other guidance that would restrict access to organ transplant services based on disability.
The House companion language, H.R. 1520, previously passed the House of Representatives on June 23, 2025. The AMA looks forward to continuing to work with the bill sponsors to see it signed into law.
Registration open for AMPAC Campaign School
For AMA members, their spouses, medical students and residents and state medical association staff who want to become more involved in the campaigning process, the 2026 AMPAC Campaign School will be taking place Sept. 10-13 at the AMA Offices in Washington, D.C.
Running an effective campaign can be the difference between winning and losing a race. That’s why the Campaign School is designed to give participants the skills and strategic approach needed out on the campaign trail. AMPAC’s team of political experts will teach participants everything they need to know to run a successful campaign.
During the two-and-a-half-day in-person portion of the program, under the direction of political experts, participants will be broken into campaign staff teams to run a simulated congressional campaign using what they’ve learned during group sessions on strategy, vote targeting, social media, advertising and more.
Registration for the 2026 Campaign School is now open. Space is limited and the deadline to register is Aug. 10 (or sooner if maximum capacity is reached).
For more information, contact [email protected].
