On April 10, CMS Administrator Mehmet Oz, MD, announced his vision for the agency, which includes a commitment to President Trump’s “Make America Healthy Again” agenda and modernizing Medicare, Medicaid and the ACA marketplace.
Here’s five things for ASCs and physicians to know about the plans:
1. CMS will first implement President Trump’s recent executive order aimed at boosting price transparency in healthcare. The order directs HHS and the departments of Labor and Treasury to “rapidly implement and enforce” healthcare price-transparency enforcement regulations. The order refers to regulations that President Trump introduced during his first term, which he said the Biden administration was “slow walking,” according to a Feb. 25 White House fact sheet.
2. CMS will work to streamline access to life-saving treatments by “equipping providers with better patient information versus unnecessary paperwork,” but there was no elaboration on how this process would be implemented.
3. Dr. Oz said there would be increased scrutiny of the Medicare Advantage program amid allegations of widespread fraud, and expressed concerns about MA sales and brokers encouraging seniors to switch to MA policies for financial gain.
4. On April 10, House Republicans approved the Senate’s fiscal 2025 budget blueprint, paving the way for key portions of President Trump’s domestic policy agenda, including potential sweeping changes to Medicaid. The House Energy and Commerce Committee must identify at least $880 billion in federal healthcare spending cuts, a figure many healthcare stakeholders expect will fall disproportionately on Medicaid.
Work requirements have been identified as a key area of the program that could face changes per the GOP’s proposal. The work requirements proposal, introduced by Sens. John Kennedy, R-La., and Eric Schmitt, R-Mo., would require able-bodied adults without dependents to work or volunteer at least 20 hours a week to receive benefits.
Some lawmakers are also eyeing cuts to the enhanced Federal Medical Assistance Percentage to curb federal spending. Under the ACA, expansion states receive up to a 90% federal match, far above the standard 50%.
On April 10, CMS said it is halting federal matching funds for state expenditures on designated state health programs and designated state investment programs “to preserve the core mission of the Medicaid program.”
5. CMS published its final rule for MA and Part D in 2026 on April 4. The final rule solidifies changes that include measures for streamlining prior authorization, tightening oversight of supplemental benefits and codifying provisions from the Inflation Reduction Act. However, CMS did not address possible expansion of coverage for GLP-1s under Medicare and Medicaid or the regulation of AI use in prior authorizations, and deferred those decisions to future rulemaking.
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