CMS Seeks to Expand the Medicare Diabetes Prevention Program (MDPP)
Lutheran Services in America Meets with CMS Staff on MDPP
Lutheran Services in America recently met with CMS staff to discuss this evidence-based prevention program aimed at preventing type 2 diabetes. Part of broader administration efforts to Make America Healthy Again, chronic disease prevention is a key priority to improve health and lower high-cost care. During the discussion, CMS highlighted recent MDPP updates and expressed strong interest in partnering with community-based organizations to reach more eligible beneficiaries.
How Members Can Help Increase Beneficiary Awareness
Interested LSA members can help connect beneficiaries to MDPP by sharing information and resources (see below) through outreach channels including through service delivery, community-based programs, and faith-based networks.
CMS Seeking Additional MDPP Suppliers
CMS also provided more information for organizations interested in becoming MDPP suppliers. Organizations that serve older adults and have experience delivering health promotion, wellness, or lifestyle change programs may be well positioned to participate directly in the program.
Learn and Share More about MDPP:
New Report Highlights Evolving Medicaid Program Integrity Strategies
A new report from the National Association of Medicaid Directors (NAMD) highlights how state Medicaid programs are building on longstanding “program integrity” efforts to prevent, identify, and address fraud, waste, and abuse while ensuring beneficiaries receive appropriate care. The report outlines four core strategies, including:
Strategy 1: Strengthening Eligibility and Provider Screening
Key state efforts include:
- Enhancing eligibility verification processes;
- Increasing the use of automated data matching;
- Conducting audits to ensure individuals receiving Medicaid coverage meet program requirements.
- Intensifying provider screening and revalidation efforts, particularly for providers identified as higher risk, through ownership disclosures, site visits, background checks, and other verification activities.
Strategy 2: Improving Utilization Management and Managed Care Oversight
State Medicaid programs continue to:
- Rely on utilization management tools, including prior authorization requirements, service limits, and clinical review processes to ensure services are medically necessary and billed appropriately.
- Work closely with Medicaid managed care organizations (MCOs), which use claims analysis, provider reviews, site visits, and special investigation units to identify potentially fraudulent activity and refer concerns for further investigation.
Strategy 3: Leveraging Data Analytics and Technology
Many states are:
- Investing in advanced data analytics, artificial intelligence, predictive modeling, and dashboard tools to identify unusual billing patterns before improper payments occur.
- The report also highlights a growing shift from a traditional “pay-and-chase” approach toward strategies that proactively flag suspicious activity and prevent inappropriate claims from being paid in the first place.
Strategy 4: Expanding Audits, Investigations, and Cross-Agency Partnerships
States are using:
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Post-payment audits, recovery audit contractors, Medicaid Fraud Control Units (MFCUs), and partnerships with law enforcement and other agencies to investigate fraud and recover funds when improper payments are identified.
New Federal Tools Aim to Support State Efforts
The report also notes several new federal initiatives designed to strengthen program integrity, including modernization of the National Provider Identifier system, enhancements to the Public Assistance Reporting Information System (PARIS), deployment of the Medicaid Emerging Vulnerability Intelligence and Actions (MEVIA) analytics platform, and development of service-specific program integrity toolkits.
Why This Matters for Providers
Providers can continue to expect closer attention to eligibility verification, provider enrollment and guidance, documentation, and claims review. Organizations serving Medicaid beneficiaries should work closely with their state Medicaid agencies and where applicable, managed care partners. The report notes that understanding these trends now can help providers anticipate operational changes, strengthen documentation and billing practices, and position themselves for success as state implementation efforts move forward
Appeals Court Allows HUD Homelessness Funding Changes to Move Forward
Court Pauses Earlier Decision Blocking FY 2026 CoC Funding Changes
Last month, we reported that a federal district court had vacated HUD's FY 2026 Continuum of Care (CoC) Notice of Funding Opportunity (NOFO), temporarily blocking significant changes to federal homelessness funding priorities. HUD appealed that decision and sought an emergency stay. The U.S. Court of Appeals for the First Circuit has now granted the stay. As a result, HUD may proceed with the FY 2026 CoC NOFO for now, even though the underlying legal challenge remains unresolved.
What This Means for Providers
For housing, shelter, and supportive service providers, this means the FY 2026 CoC competition could move forward in the near term, and application deadlines may be announced quickly. The appeal itself could take months to resolve. Because the challenged NOFO includes major changes to homelessness funding priorities, uncertainty remains for communities and providers that rely on CoC funding. Organizations should closely monitor guidance from HUD and their local Continuum of Care as the funding process and litigation continue to unfold.
Looking Ahead
Advocacy organizations challenging the NOFO are evaluating next steps while the appeal proceeds. We will continue tracking developments and any implications for providers serving people experiencing homelessness.
ARPA-H Launches New Autism Research Initiative Amidst Skepticism
The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), has launched SPECTRA (Systems for Phenotypic Evaluation, Clinical Trajectories, Response, and Agency), a new autism research initiative aimed at improving how autism is identified, understood, and supported across the lifespan. The program reportedly will use biological, clinical, behavioral, and real-world data to develop earlier and more accurate diagnostic tools, better understand individual developmental trajectories, and support more personalized interventions and services.
Skepticism and Questions Loom: Promise or Peril?
The disability community is still assessing the initiative, and reactions have been mixed Some stakeholders see promise in efforts to improve early identification, connect individuals and families to supports sooner, and move away from one-size-fits-all approaches to care. They also cite personalized supports and technologies that could improve quality of life.
At the same time, questions remain about how SPECTRA aligns with the Administration's broader autism agenda and whether the initiative will be guided by sound science and meaningful engagement with the autism community. Some advocates have also expressed concern about previous comments from HHS leadership regarding autism and are watching closely to see how the program develops.
Implications for Providers
For providers serving people with autism and their families, SPECTRA could eventually influence screening, assessment, intervention, and care models for better or worse. While the initiative is still in its early stages, this new federal investment in autism research is likely to shape future policies, clinical practices, and support services nationwide.
Congressional Republicans Propose New Anti-Fraud Initiatives
Congressional Republicans have recently introduced several new proposals focused on fraud prevention and program integrity, alongside the Trump Administration's ongoing efforts to expand federal fraud enforcement activities. The measures span health care programs, public benefit programs, and broader federal anti-fraud enforcement authorities. While the prospects for these proposals remain uncertain, they signal a continued focus on fraud prevention and oversight heading into the midterm elections.
Proposed: Health Care Fraudsters Act
The Protecting Taxpayers from Health Care Fraudsters Act would authorize future funding for federal programs and offices involved in fraud investigations, including the Health Care Fraud and Abuse Control Program and the HHS Office of Inspector General. The bill would also expand certain oversight authorities related to Affordable Care Act programs. Supporters argue these tools could strengthen the federal government's ability to investigate and prevent health care fraud, while critics have raised concerns about the scope of the proposed authorities and funding mechanisms.
Proposed: New Department of Justice Fraud Enforcement
The National Fraud Enforcement Division Act of 2026 would establish a National Fraud Enforcement Division within the Department of Justice responsible for coordinating efforts to investigate, prosecute, and address fraud affecting federal programs and the public. The proposal closely aligns with the Administration's earlier creation of a DOJ fraud enforcement division through executive action. Thus far it's unclear if the legislation is intended primarily to codify the existing structure in statute or to expand its authorities and responsibilities.
Proposed: PROOF Act Expanding AG Authority
The Preventing Rip-offs and Obtaining Oversight of Funds (PROOF) Act would allow the Attorney General to request records from states related to federally funded programs, including Medicaid, SNAP, TANF, and unemployment insurance, for fraud investigation and enforcement purposes. Privacy advocates and some state officials have expressed concerns about expanded federal access to program and identity-verification data, particularly given ongoing debates regarding federal-state data sharing and information privacy.
New DOJ Division Expands Fraud Enforcement Infrastructure
Separate from recent Congressional legislative proposals noted above, the Department of Justice earlier this year established a new Division for National Fraud Enforcement and recently finalized additional authorities related to its operations. The division is intended to coordinate federal efforts to combat fraud involving government programs and other forms of financial misconduct. As the division grows and assumes additional responsibilities, stakeholders are monitoring how it will pursue enforcement activities and coordinate with other federal agencies.
Why This Matters for Providers
Although these proposals may face a challenging legislative path, they reflect a broader and growing emphasis on fraud prevention, program integrity, oversight, and enforcement across federal health and human services programs. For LSA members and other providers, these developments could eventually influence documentation requirements, provider screening, audits, data-sharing expectations, and program oversight activities. We will continue monitoring these proposals and related administrative actions as implementation of H.R. 1 and other federal policy changes move forward.
