On April 21, the Energy & Commerce Committee held a hearing with the U.S. Department of Health & Human Services (HHS) Secretary Kennedy on President Donald Trump’s FY27 Budget Proposal. Members raised concerns about vaccine policy, health care pricing, transparency, and cost drivers, including noncompliance with price transparency requirements, variation in service pricing, and the role of programs such as 340B and supply chain factors in driving costs. Members also discussed Medicare, Medicaid, and coverage policy, as well as providers, rural hospitals and workforce, and program integrity and oversight.

On April 22, Congresswoman Mariannette Miller-Meeks, M.D., joined fellow physician members of Congress in introducing the bipartisan Medicare Advantage Improvement Act of 2026, legislation. In a press release, Congressperson Miller-Meeks noted the legislation is “aimed at restoring accountability, strengthening patient protections, and ensuring seniors receive timely, reliable care. The bill takes on growing concerns within Medicare Advantage by increasing transparency, cracking down on abusive practices, and aligning coverage standards with traditional Medicare to better serve America’s seniors.” The bill was co-sponsored by Reps. Kim Schrier, D-Wash., Gregory Murphy, R-N.C., Jimmy Panetta, D-Calif., Ami Bera, D-Calif, and Beth Van Duyne, R-Texas. The Alliance is in the process of analyzing the legislation.  

During SNP Alliance April Hill meetings, while introduced in January by Congressman Arrington (R-Texas), the Improving MA SNP Act of 2026, continues to garner attention due to technology sector interest in creating the opportunity to compete with NCQA for MOC review using Artificial Intelligence. 

Also from our April discussion, while introduced last year, pundits have begun discussing Congressman Bean (R-Florida) and Congressman Hern’s (R-Oklahoma) Apples to Apples Comparison Act. Focusing on the availability of MA data, the bill likely could be included in discussions about MA transparency and oversight. As a refresher, the legislation is aimed at flawed data which leads to flawed decisions. The Apples-to-Apples Act would require CMS to more accurately compare costs and health outcomes to ensure that seniors are able to select healthcare policies that best reflect their needs.

April 21st, a series of hearings were held on the President’s proposed budget – one in the Finance Committee and a second in the Health, Education, Labor and Pensions (HELP) Committee. Key topics included Medicare payment policy and program administration, consumer cost sensitivity, AI, and rural health and hospital sustainability.

On April 2, CMS released the Final Parts C and D Contract Year 2027 Final Rule. A SNP Alliance discussion of the Final Rule and member requests for technical support, follow up questions, and advocacy with CMS may be viewed in our Members-Only Technical Assistance Center. In terms of highlights, CMS received approximately 42,632 comments on the proposed rule and the requests for information (RFIs) contained within the rule. As per the Administrative Procedures Act, summaries of the public comments within the scope of the proposed rule and responses to those public comments are set forth in the various sections of this final rule under the appropriate heading. While CMS did not provide responses or thematic summaries of RFI comments, the Agency did RFI comment upon how the RFIs would be considered in future rule-making. In addition, CMS did not finalize the SEP for provider terminations and did not provide response to public comments on this proposal.  

In regard to H.R. 1, the Medicaid community is anticipating a series of Interim Final Rules with Comment on May 1 or the following week. Of importance to SNPs is CMS’ definition of Medical Frailty. The key issue for SNPs is the possibility of duals and other Aged, Blind and Disabled Categorical Eligibility populations being impacted based upon state interpretation of the regulatory language and/or due to information system, state Medicaid Transformed Medicaid Statistical Information Systems (T-MSIS).

On April 6, CMS released the Final Rate Notice. The SNP Alliance held an All-Member Webinar on the Final Rate Notice on April 8, 3:00 – 4:00 EST. The Webinar recording may be viewed in the Members-Only Section. In the Final Notice, CMS paused its proposed risk adjustment proposal and continued the current methodology.  

On April 9, CMMI held a webinar on LEAD ACO, click here. Of note, CMMI has not yet released information on the two states which will be picking up the Medicare-Medicaid Integration option but the SNP Alliance believes eight states are probable based upon factors such as D-SNP concentration, ACO enrollment, state experience with Integration, and number of duals. Additionally, the Center for Health Care Strategies (CHCS) has released a guide for states on LEAD ACO which can be found here. Also, Wakely has produced a helpful White Paper discussing the model from a provider perspective, including observations on the brief mention of Inferred Risk. 

On April 21, CMS Administrator Mehmet Oz announced a nationwide initiative requiring all states to submit plans within 30 days outlining how they will revalidate Medicaid providers to address program integrity concerns. CMS indicated that states that do not comply may face additional federal audits and oversight.

In regard to state activity, H.R. 1 remains front and center with State Legislatures considering changes in HCBS services and amount, scope, and duration of benefits. To-date, HI and IL have active legislation aimed at modifying their Integration programs. 

On April 28, the RAND presented on a report entitled. “State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act” during a Modern Medicaid Alliance meeting. The report provides a helpful overview of potential risks to duals and other Aged, Blind and Disabled populations' eligibility and states implement the OBBBA Work Requirements.  

On April 7, Avalere Health produced a report entitled 2027 Medicare Advantage Payments; Market Implications which includes helpful details such as percent change in MA benchmarks by county, 2026 – 2027. Click here to view the report. 

On April 23, the Paragon Health Institute released a paper examining the role of federal and state policies in driving hospital prices, consolidation, and spending growth in the U.S. health care system. The paper found that hospitals account for approximately one-third of total health care spending and that hospital prices have increased three times faster than inflation since 2000, with operating margins averaging 6.4% and total margins reaching 6.5% in 2024. The report also noted that more than 55% of physicians are now employed by hospitals and outlined policy recommendations, including site-neutral payments, enhanced price transparency, and reforms to Medicaid financing and hospital subsidy programs to improve efficiency and competition.