The Centers for Medicare & Medicaid Services July 7 released a bulletin announcing the end of its “fast-track” review process for certain Medicaid section 1115 demonstration extensions. The notice said that the July 2025 reconciliation bill included a requirement that the CMS chief actuary certify budget neutrality for section 1115 demonstrations. CMS said the current fast-track extension process could make it difficult for the agency to evaluate section 1115 demonstration renewal applications consistent with the new budget neutrality requirements. Guidance from 2015 implementing the fast-track option was formally rescinded, but the bulletin did not include an effective date. The budget neutrality requirements begin Jan. 1, 2027.