- Proposed Medicaid provider tax rule would place overly broad restrictions on state tax policies
- AMA urges CMS to stay the course on electronic prior authorization
- Action needed: CMS releases 2025 MIPS final scores; physicians have 60 days to contest their score
- CMS excludes dialysis and emergency medicine cost measures from 2027 MIPS scores
- AMA urges CMS and HRSA to expand access to high resolution anoscopy
- More articles in this issue
Proposed Medicaid provider tax rule would place overly broad restrictions on state tax policies
On Sept. 17, the AMA submitted comments (PDF) to the Centers for Medicare & Medicaid Services (CMS) pushing back on the agency's proposal to broaden the application of Medicaid provider tax restrictions beyond what is required by statute. AMA policy supports the use of provider taxes to sustain or improve Medicaid patients' access to care and opposes federal proposals that would restrict or eliminate states' ability to assess provider taxes for these purposes.
In 2025, Congress imposed new restrictions on provider taxes under Public Law 119-21 (also known as the "One Big Beautiful Bill" or H.R. 1). Congress placed new limits on the amount of revenue that states could raise through provider taxes, including effectively placing a moratorium on new taxes, freezing the rates of taxes already in effect, and beginning in October of 2027, phasing down the permissible rate of provider taxes imposed by Medicaid expansion states.
CMS' proposed rule, in addition to implementing the changes described above, would extend Medicaid's provider tax restrictions to all state taxes and fees imposed on health insurer services, a category of taxes that, with some exceptions, previously were not subject to Medicaid's provider tax rules. CMS is also proposing to eliminate a pathway for states to demonstrate that a provider tax satisfies federal requirements and narrow other state flexibilities around provider taxes.
In the comments, the AMA urged CMS not to exceed the scope of the changes mandated by Congress in H.R. 1. In particular, AMA is concerned that some of the restrictions in the proposed rule will make it harder for states to finance their Medicaid programs without providing any corresponding improvements to program integrity. The AMA is also concerned that expanding the application of Medicaid's provider tax restrictions to all taxes on health insurer services could impact states' ability to finance state-based ACA Marketplaces through user fees imposed on participating insurers, a practice that is expressly permitted by law.
The AMA also expressed concern about the cumulative impact of the changes in this proposed rule when combined with other changes to Medicaid, such as a recent proposed rule on state-directed payments and targeted practitioner payments and an interim final rule implementing community engagement requirements (also known as work requirements) scheduled to take effect on Jan. 1. The AMA submitted comments on both the state-directed payments proposed rule and the interim final rule on work requirements, and we continue to engage with CMS to minimize unnecessary coverage losses and physician burden.
AMA urges CMS to stay the course on electronic prior authorization
On Sept. 18, the AMA sent a letter (PDF) to CMS Administrator Mehmet Oz, MD, MBA, urging the agency to maintain the Jan. 1, 2027, timeline for electronic prior authorization (ePA) and reject requests for broad enforcement discretion during 2027. The AMA warned that delaying enforcement could slow development, testing and deployment of ePA, leaving physician practices dependent on faxes, phone calls, payer portals and repeated data entry while patients continue to wait for medically necessary care.
The AMA urged CMS not only to hold stakeholders to the Jan. 1 deadline, but also to ensure they are taking the steps necessary for successful implementation. Health plans must make accurate, current prior authorization and documentation requirements available through required application programming interfaces and ensure those connections function reliably; health systems and EHR vendors should give physicians advance notice of implementation timelines and planned functionality, provide education and training, offer technical and implementation support, and clearly communicate what fallback processes to expect and where to report technical or workflow problems.
These steps are particularly important given the continued burden of prior authorization. The AMA’s 2025 prior authorization survey (PDF) found that 95% of physicians report that prior authorization delays access to necessary care, 26% report that it has led to a serious adverse event for a patient in their care, and physicians and their staff spend an average of 13 hours each week completing prior authorizations. ePA can help address this burden by replacing fragmented, manual processes with integrated electronic workflows that allow physicians to identify requirements, submit documentation, and receive decisions more efficiently—and the AMA will continue pressing for timely implementation while supporting physicians as they prepare for the transition to ePA.
Action needed: CMS releases 2025 MIPS final scores; physicians have 60 days to contest their score
CMS has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2025 performance year. The 2025 final score determines the payment adjustment eligible clinicians (EC) and group practices will receive in 2027. 2027 MIPS payment adjustments will be available in approximately one month.
If an EC or group practice believes CMS calculated their final score or 2027 payment adjustment incorrectly, they must file a targeted review with CMS within 60 days. The targeted review opens with the release of final scores (now) and will close 30 days after the release of MIPS payment adjustments. CMS will announce the release of MIPS payment adjustments through the QPP listserv in approximately one month.
Examples of reasons to file a targeted review:
Data were submitted under the wrong TIN or National Provider Identifier (NPI).
You have Qualifying APM Participant (QP) status and should not receive a MIPS payment adjustment.
Performance categories weren’t automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances.
To access your MIPS final score and performance feedback and request a targeted review:
Sign in using your HARP credentials (ACO-MS credentials for Shared Savings Program ACOs); these are the same credentials that allowed you to submit your 2025 MIPS data.
Click “Targeted Review” on the left-hand navigation.
CMS generally requires documentation to support a targeted review request, which varies by circumstance. A CMS representative will contact you about providing any specific documentation required. If the targeted review request is approved and results in a scoring change, CMS will update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. Please note, unfortunately, targeted review decisions are final and are not eligible for further review by CMS.
CMS excludes dialysis and emergency medicine cost measures from 2027 MIPS scores
After analysis revealed inconsistent risk adjustment, CMS will exclude two cost measures, the Acute Kidney Injury Requiring New Inpatient Dialysis (COST_AKID_1) and Emergency Medicine (COST_EDV_1) Measures, from counting toward cost category calculations for the Merit-based Incentive Payment System (MIPS) for the CY 2025 performance period/2027 MIPS payment year. More information can be found in this CMS fact sheet (PDF).
AMA urges CMS and HRSA to expand access to high resolution anoscopy
High resolution anoscopy (HRA) has been shown to prevent the progression of anal cancer and is recommended for certain high-risk groups per society guidelines. However, there are significant access and training gaps that prevent patients from accessing this preventive cancer care. In a letter (PDF) to CMS and the Health Resources and Services Administration (HRSA), the AMA noted that federal funding mechanisms and demonstration programs can expand HRA capacity, increase the number of sites that offer the service, strengthen screening-to-treatment referral pathways, and invest in physician training, particularly in areas that are low-income, rural and/or underserved.
