Cms

• Centers for Medicare and Medicaid Services published a proposed rule on Friday requiring health insurance companies and states to resolve non-urgent prior authorization requests for prescription drugs within 24 hours. • The regulation mandates Medicaid and CHIP insurers, plus state administrators, to publicly disclose denial rates and respond faster to improve patient access. • This addresses delays in medication approvals, potentially benefiting millions enrolled in these programs amid ongoing affordability challenges.

• CMS announced the Accelerating State Pediatric Innovation Readiness and Effectiveness Model (ASPIRE), a 10-year voluntary program for up to five states. • ASPIRE targets Medicaid and CHIP enrollees up to age 21 with complex medical and behavioral needs through early identification, care coordination, and quality accountability. • A Notice of Funding Opportunity will be released later this year to solicit state participation.

• HHS and CMS announced new members for the Healthcare Advisory Committee on March 27, 2026, to enhance patient care and modernize U.S. healthcare. • Committee focuses on policy recommendations for efficiency, innovation, and better outcomes nationwide. • Initiative aims to address systemic challenges amid evolving public health needs.

• The House Energy and Commerce Subcommittee held a March 17 hearing on CMS fraud prevention, with Deputy Administrator Kimberly Brandt detailing data analytics and real-time monitoring shifts. • Republicans highlighted improper payments in hospice, home health and Medicaid, calling for stronger oversight; Democrats urged balancing enforcement with patient access. • Lawmakers addressed fraud risks in durable medical equipment amid calls to end 'pay-and-chase' models.

• CMS issued a final rule on March 23, 2026, standardizing electronic health care claims attachments and electronic signatures to replace fax and mail with digital submissions like notes, images, and reports. • The rule excludes prior authorization attachments and takes effect May 26, 2026, with compliance required by May 26, 2028 for covered entities. • This administrative simplification aims to reduce provider burden and improve efficiency in claims processing across US healthcare systems.

• CMS actuaries forecast U.S. health spending at $5.3 trillion in 2024, outpacing economic growth to hit 20% of GDP by 2033. • Projections highlight unsustainable trajectory for national health expenditures. • Policymakers face pressure to address cost drivers in insurance, drugs, and services.

The AMA submitted comments on March 13, 2026, recommending CMS actions to help states implement Medicaid community engagement requirements without causing unwarranted coverage losses for eligible enrollees. In separate marketplace plan comments, AMA stressed maintaining affordable, comprehensive coverage, warning proposed affordability boosts could destabilize risk pools and limit patient access. These advocacy efforts address national issues impacting physicians and patients amid ongoing health policy shifts. Senate HELP Committee bills from March 6 promote health care cybersecurity coordination and protections for living organ donors.