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Health Plan Accountability Update
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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.
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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.
News

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.
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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.
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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.
News

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.
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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.
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AHA-supported legislation would apply prompt payment standard to MA plans 

The AHA expressed support Sept. 22 to House and Senate sponsors of the Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), legislation that would apply a federal prompt payment standard to MA plans to help ensure that health care providers receive timely payments from MA plans for necessary patient services.
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CMS issues final rule on CY 2026 policy and technical changes to Medicare programs 

The Centers for Medicare & Medicaid Services Sept. 18 released a final rule on policy and technical changes to Medicare Advantage, the Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly for contract year 2026.
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Hospital-at-home bill considered during House Ways and Means Committee markup

The AHA submitted a statement Sept. 17 for a House Ways and Means Committee markup session on a series of health care and other bills.