Today's briefing covers two CMS-related Federal Register notices: the HHS Secretary's delegation of permissive exclusion authority under section 1128(b) of the Social Security Act to the CMS Administrator, effective immediately, and a proposed revision of the MMA file collection through which state Medicaid agencies report dual-eligibility status to CMS every day. Comments on the data collection are due by 2026-12-15.
In a Statement of Delegation of Authority published 2026-10-14, the Secretary of Health and Human Services delegated to the CMS Administrator the authorities vested in the Secretary under section 1128(b) of the Social Security Act, the permissive exclusion authority. The notice says CMS requested the delegation because, as the agency directly responsible for administering Medicare and Medicaid, it is positioned to investigate, identify and develop the evidentiary basis for permissive exclusion determinations, and that formalizing it aligns investigative and enforcement responsibilities within a single operating division, reducing redundancy and improving program integrity outcomes. The delegation revises the limitations in a 2011-03-14 delegation (76 FR 13618), may be redelegated, and excludes the authority to conduct hearings and to issue regulations. It does not affect or diminish the Secretary's earlier delegation of these authorities to the HHS Inspector General (53 FR 12993, 1988-04-20). It took effect immediately, and the Secretary affirmed and ratified actions the Administrator or subordinates took under these authorities before the effective date.
Permissive exclusion determinations can now originate in the agency that administers Medicare and Medicaid, in addition to the Inspector General, and the notice ratifies earlier CMS actions taken under the same authorities. Compliance teams at providers, suppliers and plans should track how CMS publishes and exercises exclusions under this delegation and make sure their exclusion screening and response procedures account for determinations coming from CMS as well as the Inspector General; the notice says only that the delegation will be exercised under the Department's existing policies, procedures, guidelines and regulations.
CMS proposes to revise the currently approved collection State Data for the Medicare Modernization Act (Form CMS-10143, OMB control number 0938-0958), with technical revisions to the Medicare Advantage Prescription Drug State User Guide, which holds the technical guidance and file layouts for the MMA request and response files. Under 42 CFR 423.910, Medicaid agencies in the 50 states and the District of Columbia submit at least one monthly file listing all known dually eligible beneficiaries, both full-benefit and partial-benefit, followed by daily files with changes in dual-eligibility status (accretions, deletions and changes); states have submitted the file, also called the state phase-down file, since 2005. CMS uses the data to calculate the Phased-Down State Contribution for Part D and, as it carries dual-eligibility status into systems supporting Original Medicare, Medicare Advantage and Part D, to automatically enroll individuals in Medicare drug plans or deem them eligible for the Part D low-income subsidy. The burden estimate is 51 respondents, 51 total annual responses and 4,896 total annual hours.
The notice ties benefit access directly to data latency: dual-eligibility status can change at any time in a month, and CMS says that without daily exchanges it would lag in automatically enrolling people in drug plans or deeming them eligible for the low-income subsidy. State Medicaid data teams should review the technical revisions to the State User Guide against their file-build and validation processes, and send any comments on burden or data quality by 2026-12-15.
