The following is the latest health policy news from the federal government for January 23-29.  Some of the language used below is taken directly from government documents.

Congress 

The Senate today failed to advance a package of the remaining six FY 2026 appropriations bills, including funding for the Department of Health and Human Services.  Democratic senators continue  negotiating with the White House on how to proceed with Department of Homeland Security (DHS) funding, including the possibility of separating the DHS bill from the broader appropriations package and making targeted amendments to that measure.  The Labor, HHS, Education, and Related Agencies bill, which contains the health care extenders, is unlikely to be revised but any changes to the six-bill package would require another vote in the House.  Currently, it remains unclear whether the House will accept changes to the appropriations bills.  Even if a deal is made, the House is not scheduled to return to Washington until Monday and the current continuing resolution expires tomorrow (January 30).  A lapse between votes will result in at least a temporary partial government shutdown.

In this event, CMS is expected to handle claims for Medicare fee-for-service telehealth services in the same way it has done during previous lapses in federal funding, which has been to hold telehealth claims until providers are otherwise notified.  For additional information on HHS and CMS operations during a government shutdown, see the previously published FY 2026 contingency staffing plan and CMS’s explanation of how it plans to proceed in the absence of an approved federal budget.  CMS is expected to release an updated contingency plan before the weekend.

Centers for Medicare & Medicaid Services

• CMS has finalized a new rule about Medicaid provider taxes that implements changes to those taxes as mandated by H.R. 1and eliminates a mechanism that states have long used to help finance their Medicaid programs.  Through this mechanism, states levied higher tax rates on Medicaid managed care organizations and other Medicaid providers while using the proceeds from these taxes to obtain federal Medicaid matching dollars and then used some of the revenue from the matching funds to repay some of the providers for much of the tax they paid.  The final rule seeks to ensure that health care-related taxes are generally redistributive by preventing taxes that impose higher tax rates on providers that primarily serve Medicaid beneficiaries than on other providers that serve a relatively smaller number of such beneficiaries and establishes that the new requirements will apply on a per class basis.  The rule also states that regardless of whether a tax meets the certain standards, it would not be considered “generally redistributive” if it has certain described attributes that are contrary to the tax program being generally redistributive in nature.  The final rule creates the following transitions of one, two, and three years:

Learn more about the rule from this CMS news release; an accompanying fact sheet; and a preview version of the final rule, which will officially be published on February 3.  The rule takes effect on April 3.

• CMS has published its CY 2027 Medicare Advantage and Part D Advance Notice, which presents how it intends to pay Medicare Advantage, Part D prescription plans, and PACE programs in 2017.  Highlights include:
  • An increase of 0.09 percent for Medicare Advantage plans based on an effective growth rate of 4.97 percent less adjustments for changes in the Star Ratings, changes in risk modeling, and changes in the sources of diagnoses (see below).
  • Changes in the Medicare Advantage risk adjustment model, including the exclusion of diagnosis information from unlinked chart review records, which have historically resulted in additional claims not associated with a specific beneficiary encounter.  CMS estimates this will reduce Medicare payments to Medicare Advantage plans by $7 billion.
  • Revising the risk modeling for Part D plans by calibrating the model separately for Medicare Advantage prescription drug plans and standalone Part D plans.
  • The continued transition of PACE payments toward risk adjustment data submitted to the encounter data system rather than the legacy risk adjustment processing system.
  • Changes in Star Ratings updates.

While CMS collects comments on its Advance Notice, this is unlike formal rulemaking because CMS is not required to respond to comments in its final notice, which must be released by April 6 to continue the bidding timeline.  The deadline for submitting comments is February 25.

CMS also seeks feedback on new measure concepts to consider for Star Ratings in the future.

Learn more about the 2027 Medicare Advantage and Part D Advance Notice from this CMS news release; an accompanying fact sheet; and the formal 2027 Advance Notice.

• CMS has issued a proposal rule that seeks to strengthen federal oversight of Organ Procurement Organizations (OPOs).  The proposal seeks to sharpen the framework for upcoming OPO re-certification cycles and reinforce clear, enforceable standards to protect patients and ensure that viable organs are safely recovered and transplanted.  The proposed rule would enhance performance measures and tighten documentation; define and deter unsafe practices; maximize use of medically complex organs; increase accountability and smart competition; and remove a barrier to new OPO certification.  The proposal is the latest step in the continuing modernization of the national organ transplant system.  Learn more about the proposed rule from this CMS news release; an accompanying fact sheet; and this preview of the proposed rule.  The deadline for submitting written comments will be 60 days after the rule’s official publication, which is currently scheduled for January 30.
• CMS announced that 10 health technology companies that have current Medicaid eligibility and enrollment contracts with states have voluntarily pledged to help states successfully prepare for and implement new Medicaid community engagement requirements that were included last year in the bill previously known as H.R. 1 and often referred to as the One Big Beautiful Budget Bill Act and that must be implemented by January 1, 2027.  These companies have informed CMS that they intend to offer states more than $600 million in no-cost and significantly discounted technology products and services to support the implementation of the community engagement requirement.  Learn more about the community engagement requirement, how the $600 million in resources will be used, and the identity of the 10 companies involved from this CMS news release and an accompanying fact sheet.
• CMS has posted a brief summary of Affordable Care Act marketplace activity during the open enrollment period that ended on January 15.  According to the report, 23 million consumers signed up for 2026 individual market health insurance coverage, including 15.8 million plan selections in the 30 states using the HealthCare.gov platform for the 2026 plan year and 7.2 million plan selections in the 20 states and the District of Columbia with state-based exchanges.  Total nationwide plan selections include 3.4 million consumers who are new to the marketplaces for 2026 and 19.6 million consumers who had active 2025 coverage and selected a plan for 2026 coverage or were automatically re-enrolled.  Overall, enrollment for health insurance through the federal exchange and state exchanges fell by 1.1 million, or five percent, from last year.  Forty-one states saw their enrollments decline while enrollment rose in nine states and the District of Columbia.  Learn more from this CMS fact sheet.
• CMS has selected 15 high-cost prescription drugs covered under Medicare Part D and drugs payable under Medicare Part B for the third cycle of the Medicare Drug Price Negotiation Program.  CMS also selected one previously negotiated drug for the program’s first renegotiations.  Negotiations with participating drug companies will be undertaken in 2026 and any negotiated and renegotiated prices will become effective January 1, 2028.  Learn more about the program and find a list of the drugs chosen for negotiations in this CMS news releaseand an accompanying fact sheet.
• CMS has issued an Advance Notice of Proposed Rulemaking seeking public feedback on potential approaches to strengthening the American-made supply chain for personal protective equipment and essential medicines.  Building on lessons learned during the COVID-19 public health emergency, the agency is exploring ways to reduce reliance on foreign-made medical supplies and enhance the nation’s readiness for future emergencies.  CMS seeks input on future supply chain policies to advance national security, strengthen domestic manufacturing capacity, improve care quality, and support a more resilient health care system. In particular, it seeks comments on new ways the agency may consider to promote domestic purchasing by hospitals that participate in the Medicare program, including what it describes as “… the potential creation of a new ‘Secure American Medical Supplies’ designation for hospitals committed to American-made purchasing, and streamlined payment approaches to help offset the resource costs of domestic procurement.”  CMS also seeks input on a potential new quality measure as part of the hospital inpatient quality reporting program that could promote hospital commitment to invest in domestic procurement.  Learn more from this CMS news release and the proposed rule.  The deadline for submitting comments is March 30.
• CMS has sent an informational bulletin to the states presenting its 2026 federal poverty level standards.  The 2026 guidelines reflect a 2.6 percent price increase between calendar years 2024 and 2025 and other adjustments.  These standards are used in eligibility criteria for programs such as Medicaid and the Children’s Health Insurance Program (CHIP).  Learn more from this bulletin from CMS to the states.
• CMS has posted a bulletin updating the correct billing requirements for Method II critical access hospital providers performing professional emergency department procedures.  Find the bulletin here.  The update takes effect on April 24.
• CMS has published updates to the master list of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items potentially subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements.  It also has published updates to the required DMEPOS face-to-face encounter and written order prior to delivery list as well as updates to the DMEPOS required prior authorization list.  Learn more from this formal notice, which takes effect on April 13 and lists all of the additions to these lists and their HCPCS codes, and from the master list web page.
• CMS has sent a memo to state survey agencies updating policies governing its Special Focus Facility Program, which was established in 1998 to improve quality of care at nursing homes with a history of serious, persistent deficiencies.  The new memo updates guidance introduced in a CMS memo of 2022 and updated the following year.  The primary change is a greater emphasis on falls in the selection of programs that will be brought into the program.  Find the latest iteration of this guidance memo here.
• CMS has posted a short resource for skilled nursing facility providers that illustrates how the combination of Medicare five-day and prospective payment system discharge assessments can affect the annual payment update calculation (APU).  The APU calculation is a compliance-based, two percentage-point adjustment to the Medicare payment rate that is determined by a facility’s submission of required quality measures.  For FY 2026, skilled nursing facilities must report 100 percent of required measures on at least 90 percent of all Minimum Data Set assessments, with non-compliance resulting in a two-percentage point reduction.  Find that resource here.  CMS expects to offer providers more in-depth training focused on the criteria for success for the skilled nursing facility quality reporting program APU in the near future.
• CMS has updated its Open Payments data.  CMS Open Payments is a national transparency program that collects and publishes data on payments and other transfers of value from drug and medical device companies to physicians, physician assistants, nurse practitioners, and teaching hospitals.  This publicly accessible database reveals financial relationships, including research payments, speaking fees, meals, travel, and ownership stakes.  Find the updated database on CMS’s Open Payments web page
• CMS and its eCQI Resource Center are now accepting public feedback on draft Fast Healthcare Interoperability Resources® (FHIR®) Digital Quality Measures (dQMs) to be considered for future use in CMS quality reporting programs.  FHIR is the next-generation standard for electronic health care data exchange and is designed to improve interoperability across clinical settings.  Learn more about FHIR, the draft quality standards, and how to submit comments from this CMS notice.  The deadline for submitting comments is February 23.
• CMS has added the following items to its Quality Payment Program resource library.  (Note:  clicking these links may give a prompt to download a file that may be a zip file.)
  • MIPS Quality Performance Category Fact Sheet
  • Small Practices Guide: Getting Started with MIPS eCQM Reporting
  • Quality Performance Category: Learning about Collection Types
  • MIPS Improvement Activities Performance Category Fact Sheet

Technical Expert Panels

• CMS has hired an external contractor to develop a Medicaid total cost-of-care measure for use initially in the CMS Innovation Center’s Innovation in Behavioral Health Model.  This contractor will be convening groups of stakeholders and experts to contribute direction and input on its work and analysis, so the contractor is seeking individuals with relevant experience and expertise who can provide input and advice on the approach for measuring total cost of care for services provided under the Innovation in Behavioral Health Model to adult Medicaid beneficiaries with moderate to severe behavioral health conditions and substance use disorder.  Learn more about the specific skills, expertise, and experience sought for the panel, the time commitment involved, and how to apply to participate from this CMS notice(scroll down to and then click “Development of Medicaid Total Cost of Care Measure).  The deadline for submitting applications is February 24.
• CMS has hired an external contractor to help develop, reevaluate, and implement outpatient outcome and efficiency measures.  This contractor will be convening groups of interested parties and experts to contribute direction and input on the development of a new measure using administrative claims data to assess excess days in acute care following an outpatient procedure or surgery for use in the Hospital Outpatient Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, and Rural Emergency Hospital Quality Reporting Program.  Learn more about the specific skills, expertise, and experience sought for the panel, the time commitment involved, and how to apply to participate from this CMS notice(scroll down to and then click “Development, Reevaluation, and Implementation of Outpatient Outcomes/Efficiency Measures).  The deadline for submitting applications is February 20.

Department of Health and Human Services

• HHS and the departments of Labor and the Treasury have certified a new Independent Dispute Resolution entity to adjudicate health care payment disputes under the No Surprises Act.  This brings to 16 the number of such entities.  Learn about the newest approved entity and find a link to a list of all of the entities and their current fees from this CMS announcement.
• HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) has published a guide to help communities safely and effectively integrate behavioral health crisis response systems.  The framework provides guidance on reducing legal risk, clarifying roles, strengthening partnerships, and improving coordination between 988 and 911 to ensure that people in crisis receive timely, appropriate, and compassionate care.  Find the guide here.
• HHS and the Department of State have finalized the U.S.’s exit from the World Health Organization (WHO).  HHS states that the decision was reached based on “…WHO’s handling of the COVID-19 pandemic originating in Wuhan, China; its persistent refusal to implement necessary reforms; and its lack of accountability, transparency, and independence.”  Learn more from this Centers for Disease Control and Prevention news releaseand HHS’s fact sheet on the withdrawal.

HHS/Office of the Assistant Secretary for Planning and Evaluation (ASPE)

• ASPE has published a report about the development of a model that uses multiple claims-based indicators to identify Medicaid beneficiaries who have a disability using existing Medicaid claims data.  Find that report here.
• ASPE has posted a study examining how people with Alzheimer’s disease and related dementias use hospice compared to patients who have other terminal diagnoses and how hospice characteristics shape those care patterns.  Find that study here.
• ASPE has prepared a report reviewing state and federal caregiver tax credit laws and bills.  Go hereto find that report.
• ASPE has published its annual report and infographics on building the data capacity for patient-centered outcomes research.  Find those resources here.

HHS/Office of the Inspector General (OIG)

• The OIG has published a summary of its audit of Medicare Administrative Contractor (MAC) information security programs for FY 2024.  See the OIG’s findings in this report.
• Increased genetic testing drove rising Medicare Part B spending on lab tests in 2024, the OIG concluded after a recent evaluation.  Learn more about what the OIG found in this report.
• The OIG has published new guidance clarifying how pharmaceutical manufacturers can offer lower-cost prescription drugs directly to patients, including those enrolled Medicare and Medicaid, in a manner that is low risk under the federal anti-kickback statute.  The guidance is intended to support efforts to make medically necessary drugs more affordable while protecting patients and federal health care programs from fraud and abuse.  It also seeks to align with administration’s broader effort to lower drug prices, increase transparency across the prescription drug market, and expand the availability of affordable direct-to-consumer pharmaceuticals as part of the planned TrumpRx program.  The guidance does not change the federal anti-kickback statute itself and does not address financial relationships between manufacturers and other parties such as physicians, pharmacies, pharmacy benefit managers, or marketers.  Learn more about the new guidance from this HHS news releaseand the published guidance.  Also, in anticipation of the launch of TrumpRx, the OIG has issued a request for information seeking public input on creating a formal regulatory safe harbor on matters related to direct-to-consumer sales.  Find the request for information here.  The deadline for submitting comments is March 30.

Medicaid State Plan Amendments 

CMS has approved the following state plan amendments for Medicaid and CHIP programs.

• To North Carolina, extending the temporary payment rate and setting new ongoing payment rates for health home services.
• To Georgia, implementing the optional exception to the Four Walls requirement for behavioral health clinics and clinics located in rural areas.
• To Georgia, increasing the reimbursement rate for the newborn screening process from $63.00 to $80.40 per newborn admission.
• To the District of Columbia, updating its Medicaid program to exclude certain high-cost curative therapy drug products from the DRG reimbursement system and to reimburse for them under fee for service.
• To the District of Columbia, amending Enhanced Ambulatory Patient Grouping carve-out drugs.
• To Alaska, providing coverage of screening, diagnostic, and targeted case management services for eligible juveniles who are inmates of a public institution in accordance with Section 5121 of the Consolidated Appropriations Act of 2023.
• To Alaska, providing expansion population coverage of screening, diagnostic, and targeted case management services for eligible juveniles who are inmates of a public institution in accordance with Section 5121 of the Consolidated Appropriations Act of 2023.
• To North Dakota, providing coverage for community paramedic and emergency medical technician services.
• To North Dakota, providing coverage for community health worker services.
• To California, opting the state out of imposing pre-death liens under the Tax Equity and Fiscal Responsibility Act.
• To Maine, extending the medication-assisted treatment benefit as mandated by Section 201 of the Consolidated Appropriation Act of 2024, permanently removing the end date of September 30, 2025.
• To Massachusetts, updating the methods and standards used by the state for payment for sterilization clinic services.
• To New York, adding a 2.6 percent targeted inflationary increase to psychiatric residential treatment facilities.
• To Utah, implementing an annual rebasing update.
• To Utah, implementing medical transplant organ acquisition costs for covered organ transplants reimbursed via a separate, unbundled payment pool.
• To Illinois, increasing the reimbursement rate for facilities licensed by the Department of Public Health under the ID/DD Community Care Act as an ID/DD facility and medically complex for the developmentally disabled facilities licensed under the MC/DD Act.

HHS Newsletters, Reports, and Videos

• CMS – MLN Connects – January 29
• CMS – CMS has posted a video presenting a brief tutorial for Medicare Diabetes Prevention Program supplierson how to submit fee-for-service claims to Medicare Administrative Contractors (MACs) for the services they provide to program participants using the free PC-ACE software.
• CMS – earlier this month, CMS held a webinar on its PEPPER release for the third quarter of 2025.   CMS has now posted a video of that webinar; find it here.  CMS’s Program for Evaluating Payment Patterns Electronic Report, or PEPPER, is a free, CMS-sponsored analytics report designed to help health care providers identify potential risks for improper Medicare payments.
• CDC – Morbidity and Mortality Weekly Report– “Continuity of Care for Patients with Tuberculosis Relocating to Other Countries — CureTB Program, 2016–2023” – January 22.
• HHS Health Resources and Services Administration (HRSA) – earlier this month, HRSA held a webinar for potential applicants for financial assistance from the agency’s national technical assistance program to facilitate the development, delivery, and coordination of care by existing and potential Health Center Program grantees and look-alikes.  HRSA has posted a video of that webinar; find it here.
• HHS – last fall, HHS’s Office of Human Research Protections held a webinar on ethnical pathways in gene therapy and sickle cell disease clinical trials.  Find a video of that webinar here.
• Agency for Healthcare Research and Quality – AHRQ News Now – January 20.

Centers for Disease Control and Prevention (CDC)

The CDC is inviting comment on a proposed new information collection project titled “Evaluation of the Supporting Young Breast Cancer Survivors, Metastatic Breast Cancer Patients, and their Families Program.”  The program was created in 2010 and now, the CDC proposes evaluating its fourth program cycle to examine the funded organizations that provide structured support services, resources, or education to young breast cancer survivors, metastatic breast cancer patients, their families, health care providers, community health workers, and patient navigators.  The evaluation will include two primary data collection methods:  in-depth interviews and a web-based survey with each of the 11 funded organizations.  Data collection will be facilitated annually with key programmatic staff from the funded organizations to better understand implementation efforts, challenges faced, and outcomes achieved.  Learn more about the program and its objectives and the proposed evaluation and how it would be conducted, if approved, from this formal notice.  The deadline for stakeholders to submit comments about the proposed data collection is March 30.

Medicare Payment Advisory Commission (MedPAC) 

MedPAC has commented on the proposed CMS rule “Medicare Program; Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program,” which includes provisions that would revise regulations for the Medicare Advantage program and the Prescription Drug Benefit (Part D) program.  MedPAC’s comments focus on strengthening marketing oversight and broker regulations; refining thirdparty marketing organization requirements; improving network adequacy reporting; updating the Medicare Advantage and Part D star ratings systems; evaluating CMS’s enrollment policies; and assessing the growth and performance of chronic condition (C-SNP) and institutional special needs (I-SNP) plans.  Learn more from MedPAC’s comment letter to CMS.

Medicaid and CHIP Payment and Access Commission (MACPAC) 

MACPAC has commented on the CMS proposed rule “Medicare Program; Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program.”  In response to the proposed rule’s request for information, MACPAC provided input on the potential regulatory changes affecting dually eligible beneficiaries, including revisions and updates to previously finalized Dual Eligible Special Needs Plan (D-SNP) policies.  Find MACPAC’s letter to CMS here.

Congressional Research Service

The Congressional Research Service has published a report on litigation over state attempts to lower drug costs through the use of prescription drug affordability boards.  Find that report here.

Stakeholder Events

CMS Center for Clinical Standards & Quality – Stakeholder Webinar – February 4

CMS’s Center for Clinical Standards & Quality (CCSQ) will hold a stakeholder webinar on Wednesday, February 4 at 3:00 (eastern).  During the webinar, CCSQ staff will provide an update on its work to strengthen health care quality, safety, and coverage and discuss the latest on recent policy developments and how these efforts seek to accelerate progress toward improving care and outcomes for beneficiaries in Medicare, Medicaid, and the marketplace.  Go here to register to participate.

CMS – Hospital Price Transparency Webinar – February 11

CMS will hold a webinar on Wednesday, February 11 to review with stakeholders the revised hospital price transparency requirements that were included in its 2026 Medicare hospital outpatient prospective system regulation and for which the agency will begin enforcement on April 1.  Go here to participate in that webinar.

HHS/Office of the Assistant Secretary for Technology Policy – ASTP Annual Meeting – February 11-12, 2026

HHS’s Office of the Assistant Secretary for Technology Policy will hold its annual meeting in Washington, DC on February 11-12, 2026.  The meeting will include in-person education and plenary sessions and networking opportunities for the health IT community.  The main stage plenary sessions will also be available for viewing online.  Find the meeting agenda here; registration information is not yet available.

HHS Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology/Health Information Technology Advisory Committee – February 19

The Health Information Technology Advisory Committee of HHS’s Office of the Assistant Secretary for Technology Policy will hold its next meeting on Monday, February 19 at 10:00 (eastern).  This committee’s role is to identify priorities for standards adoption and make recommendations to the Assistant Secretary for Technology Policy.  Learn more about the committee, its structure, and its purpose from this HHS notice, which also outlines the meeting’s agenda.  Information about how to participate in the meeting is not yet available but when it is it will be posted here.  Other 2026 meetings will be held on May 7, September 24, and November 5,

CMS – 2026 CMS Burden Reduction Conference – February 25

CMS will hold its 2026 Burden Reduction Conference on Wednesday, February 25.  The conference will be held in Washington, D.C., with options for individuals to attend in person or participate virtually.  Learn more from this CMS notice.  Registration information is not available at this time.

CMS – eCQI Resource Center – Expert-to-Expert Webinars on eCQM Annual Updates for 2026 – February 26 and March 5

CMS’s eCQI Resource Center will hold expert-to-expert webinars offered in collaboration by the Joint Commission, CMS, and eCQM stewards.  The webinars will address the eCQM annual updates for 2026 implementation and offer continuing education credits for the live broadcast.  The webinar will address frequently asked questions and participants can submit questions for response.  There will be two sessions:  on Thursday, February 26 and the following Thursday, March 5 (both at 1:00 (eastern).  Learn more about the webinars, the specific subjects to be addressed at each, how to register to participate, and the availability of slides, recordings, and transcripts of the sessions from this CMS notice.

MedPAC – Commissioners Meeting – March 2-3

MedPAC’s commissioners will hold their next public meeting virtually on Monday, March 2 and Tuesday, March 3.  An agenda and registration information are not yet available but when they are they will be posted here.

MACPAC – Commissioners Meeting – March 5-6

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, March 5 and Friday, March 6.  An agenda and registration information are not yet available but when they are they will be posted here.

CMS – 2026 CMS Quality Conference – March 16-18

CMS will hold its 2026 Quality Conference on Monday, March 16 through Wednesday, March 18 in Baltimore.  The theme of the conference will be “Make America Healthy Again:  Innovating Together for Better Health.”  Interested parties can participate in person or virtually.  Learn more about the conference and how to register to participate from this CMS announcement.