OIG Audit Determines MACs Failed to Consistently Meet Medicare Cost Report Oversight Requirements
An HHS-OIG audit report determined that for federal fiscal years 2019-2021, the Medicare Administrative Contractors (“MACs”) did not consistently meet the Medicare cost report oversight requirements. CMS identified audit issues among the MAC jurisdictions. MAC officials attributed the issues to unclear guidance from CMS, limited feedback on the cost report reviews, inadequate training, and staffing and workload issues.
CMS Issues Proposed Rule to Combat Improper ACA Enrollment
CMS issued a proposed rule aimed at addressing improper enrollment impacting the Affordable Care Act (“ACA”) Health Insurance Marketplaces. According to CMS, the Proposed Rule outlines standards for the Marketplaces, addresses additional safeguards to protect consumers from improper enrollment, and establishes standards to ensure integrity in the Marketplaces. Key provisions include: shortening the annual open enrollment period; requiring Marketplaces to reinstitute pre-enrollment verification of eligibility for special enrollment periods (“SEPs”), revoking Deferred Action for Childhood Arrival recipients from the definition of “lawfully present” for eligibility and enrollment; eliminating SEPs for persons with annual household incomes below 150% of the federal poverty line; and adding sex-trait modifications to the list of items and services that may not be covered as “essential health benefits” beginning in plan year 2026. These are some pretty significant changes. Please note that the comment period closes on April 11, 2025.
HHS to Extend Opioid Crisis Public Health Emergency
HHS Secretary Robert F. Kennedy, Jr. renewed the public health emergency declaration pertaining to the nationwide opioid crisis, which allows HHS to continue to leverage expansive authorities to conduct activities in response to the opioid overdose crisis. HHS has used the public health emergency declaration to carry out various programs, including facilitating voluntary information collection, expediting projects related to substance use disorder treatment, and expediting support for research on opioid use disorder treatments.
President Trump Nominates Susan Monarez, Ph.D. for CDC Director
President Trump announced Susan Monarez, Ph.D. as the nominee to serve as the next director of the Centers for Disease Control and Prevention (“CDC”). Dr. Monarez currently serves as the acting director and ATSDR administrator of the CDC. Dr. Monarez has 20 years of government experience. If approved, Dr. Monarez would report to HHS Secretary Robert F. Kennedy, Jr. and manage CDC’s $17.3 billion annual budget.
- * * *