Medicaid SDP Proposed Rule, UHS Mgmt Update, ACHC & CTEV Follow-Ups - Thur. 5/21 HeartBeats

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Medicaid SDP Proposed Rule, UHS Mgmt Update, ACHC & CTEV Follow-Ups - Thur. 5/21 HeartBeats

event titled “A Conversation About The Hospital Cost

Crisis and What To Do About It”. The discussion will focus on a new Paragon research

paper examining how government policies have fueled consolidation and weakened

competition and contributed to hospital prices rising above inflation, and reforms aimed

at lowering costs for patients, employers, and taxpayers. (Paragon Health Institute, 5/26)

Link to Webinar

As states await CMS • CMS To Limit Self Attestation In Work Reqs Exemptions:

guidance on the medically frail exemption, including eligibility criteria and possible self-

attestation pathways, advocates and Medicaid sources say they are hearing that CMS

intends to turn the medically frail definition toward a work-ability definition and restrict self-

attestation. (Inside Health Policy, Dorothy Mills-Gregg, 5/20/26)

HHS Office of • PBMs Argue HHS OIG Report Proves Consolidation A Non-Issue:

Inspector General issued a report after evaluating a sample of 60 high-cost and high-

use drugs, finding that the difference in the total net cost of drugs between vertically

integrated Medicare Part D sponsors and non-affiliated plan sponsors was less than 1%.

PBM lobby PCMA claims the report vindicates integrated health plans, arguing they do not

lead to higher drug costs and provide cost efficiencies and improved patient experience

while the National Community Pharmacists Association (NCPA) argue the report exposes

the enormous market power PBMs wield and the opacity of their practices, and that

data limitations prevent any definitive conclusions about PBM behavior toward affiliated

pharmacies. (Inside Health Policy, Office of Inspector General, 5/20/26) Link To Report;