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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.
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.
Rhode Island district court denies drug company efforts to block state’s 340B contract pharmacy law
The U.S. District Court for the District of Rhode Island Sept.
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 says HRSA vastly underestimates costs 340B Rebate Pilot Program will inflict on hospitals, urges agency to delay implementation
The anticipated burdens on hospitals to comply with the Health Resources and Services Administration’s 340B Rebate Pilot Program far exceed the agency’s estimates, and HRSA should delay the program
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.
Optional letter of intent on applying for CMS rural health fund due Sept. 30
States have until Sept. 30 to submit an optional letter of intent to the Centers for Medicare & Medicaid Services indicating they plan to apply to the Rural Health Transformation Program.