cms
Every record this desk has filed under cms, newest first, each with the number of sources it can still show you.
CMS organ procurement rule revises service-area competition and quality requirements while keeping performance tiers
A CMS final rule scheduled for November 3 revises how organ procurement organizations can serve and compete for donation service areas and how they handle appeals and quality problems. CMS says the donor and transplant outcome measures and three-tier accountability structure stay in place. The rule's 60-days-after-publication effective date is bracketed in the public-inspection copy, so no fixed effective date has yet been printed there.
Also filed underorgan-donationtransplantationmedicarefederal-register
CMS projects the national average Medicare Advantage premium will fall to $12.00 a month in 2027 from $14.37; Open Enrollment runs October 15 to December 7
CMS's September 28 release projects a lower national average Medicare Advantage premium for 2027, $12.00 a month against $14.37, and the average stand-alone drug-plan premium up less than $1. Its Arizona sheet gives that state's average MA premium as $4.47 for 2026 and $2.81 for 2027. An average is not any one plan's premium. Open Enrollment runs October 15 to December 7; Medicare.gov advises reviewing the plan's Annual Notice of Change.
Also filed undermedicaremedicare-advantagepart-dopen-enrollmentarizona
CMS's final GLOBE rule, scheduled to publish October 2, adds rebates on certain Part B drugs tied to other countries' prices and can cut some patients' coinsurance from April 2027.
CMS's final rule creating the GLOBE Model is on public inspection and scheduled to publish October 2; it takes effect November 30, 2026. Makers of certain Medicare Part B drugs must take part and may owe rebates measured against other countries' prices. From April 1, 2027, people in Original Medicare in randomly chosen ZIP codes can pay less coinsurance on covered drugs. CMS says patients do not have to enroll or take any action.
Also filed undermedicareprescription-drugspart-bfederal-registerdrug-pricing
CMS canceled about 315,000 HealthCare.gov policies covering more than 760,000 people on August 31. Its new broker rule describes them as broker-assisted enrollments with unverified citizenship or immigration documentation, no identified claims and no consumer contact, and says CMS's additional preventive controls will not be fully operational before Open Enrollment opens November 1.
On August 31 the Centers for Medicare & Medicaid Services canceled approximately 315,000 Plan Year 2026 policies covering more than 760,000 people in the federal Marketplace. CMS's September 22 fact sheet says the cancellations followed confirmation that the enrollments were unauthorized, and that CMS expects about $2.2 billion in advance premium tax credits to be returned. The interim final rule published September 23 (CMS-9872-IFC, 91 FR 60317) describes the same policies as enrolled with agent or broker assistance, without verified citizenship or immigration documentation, where insurers could identify no claims and could not reach the consumer. The rule, effective September 22, bars agents and brokers who had no 2026 Exchange agreement from registering for Plan Year 2027 until February 1, 2027. It cites more than 624,000 confirmed complaints of unauthorized enrollment or plan switching from 2023 through 2025, and says CMS's additional preventive controls will not be fully operational before Open Enrollment opens November 1. Comments are due November 21. None of the documents says how the people whose coverage was canceled were told, or how anyone canceled in error gets coverage back.
Also filed underhealth-insuranceacamarketplaceinsurance-brokersconsumer-protectionfederal-register
Medicaid states must show that their fixes for eligibility errors will not wrongly deny coverage. GAO found that check missing from all 14 plans it reviewed, and in one state more than 30 percent of sampled denials were errors.
When a state's Medicaid eligibility reviews find errors, it must send CMS a corrective action plan, and each plan must evaluate whether the fixes could lead to more improper denials. GAO's report released September 17 reviewed the plans of seven states and found that evaluation missing from all 14 plans, while CMS accepted them anyway. It also found CMS does not analyse errors and fixes across states, so one state's lesson does not reach the other 50. The stakes run both ways: GAO counted 2,789 eligibility errors in states' reviews since 2019, most from caseworkers and missing documents, and a separate sample of denials found error rates of 12 percent or more in five of the seven states in at least one year, above 30 percent in one. GAO made two recommendations. HHS agreed with one and said the other was already done; GAO disagreed.
Also filed undergaomedicaidhealth-coverageeligibilityoversight
About 4.4 million people with ACA marketplace coverage are in plans that cover abortions beyond the federal exceptions, GAO counted. The law requires a separate $1-a-month charge for that coverage, and GAO found two of 13 insurers it checked were not billing it the ways CMS allows.
GAO's September 15 report, requested by members of Congress, counts which 2026 ACA marketplace plans cover abortion services beyond the cases where federal funding is allowed, and checks how insurers keep that money separate as the law requires. In the 50 states and D.C., 1,719 of 6,655 plans (26 percent) covered them, in 19 jurisdictions, and about 4.4 million enrollees (about 24 percent) were in such plans in June. No plan in the 25 states that restrict this coverage offered it. All 15 insurers GAO surveyed charge the required minimum of $1 per enrollee per month, and those that shared estimates put the actual cost below 50 cents. Two of 13 insurers that bill enrollees directly did not use one of the billing methods CMS regulations allow, and one insurer had no required segregation plan for one state. CMS told GAO it does not collect those plans because the law does not require it to. GAO made no recommendations and does not find that federal funds paid for abortions.
Also filed undergaohealth-insuranceacamarketplaceabortion-coverage
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