The following is the latest health policy news from the federal government for April 24-30.  Some of the language used below is taken directly from government documents.

Congress

  • Yesterday, House Republicans adopted the Senate’s budget resolution, clearing the way for the party-line reconciliation process to move into the drafting phase.  The limited budget resolution for Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection instructs the Senate Judiciary and Homeland Security committees to write legislation by May 15.  Today, the House passed the Senate’s spending bill to fund the rest of the Department of Homeland Security, including FEMA.
    • Even if this reconciliation package excludes health care provisions, lawmakers have not dismissed the possibility of a third reconciliation bill before the mid-term elections.  Such legislation could potentially include any of a number of health care provisions, such as expanded access to health savings accounts (HSAs); changes to the rate at which the federal government matches state Medicaid spending (FMAP); changes to Medicaid pharmacy benefit manager (PBM) spread pricing; expanded site-neutral payment policies; and others.
    • As lawmakers weigh health care provisions for reconciliation or an end-of-year package, the House Energy and Commerce Committee has begun marking up health care bills and the Ways and Means Committee is expected to follow.
  • The House Ways and Means Committee held a hearing this week with health system CEOs, including executives from HCA Healthcare, CommonSpirit Health, NewYork-Presbyterian, and ECU Health, as well as the president of the organization Protect Our Care.  In his opening remarks, Chairman Jason Smith (R‑MO) underscored the need to address site‑neutral payment policies, the 340B program, and rural reclassification of urban hospitals, framing these issues around hospital system profitability and patient costs.  Witnesses responded by emphasizing their essential role in maintaining access to care for rural and underserved populations and their ongoing investments in community health.  View Chairman Smith’s press release here and the full hearing here.

Centers for Medicare & Medicaid Services (CMS)

  • CMS has extended the deadline for organizations to apply to participate in the first performance period of its ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model to May 15; that performance period will begin on July 5.  The ACCESS Model seeks to test an outcome-aligned payment approach in original Medicare to expand access to new technology-supported care options that help people improve their health and prevent and manage chronic disease.  Organizations that apply after that May 15 deadline will be considered for a new performance period that will begin on January 1, 2027.  Learn more from the ACCESS Model web page.
  • CMS has extended the deadline for drug manufacturers to apply to participate in its GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model; the new deadline is June 11.  Under the GENEROUS Model, manufacturers will provide supplemental rebates to participating states for drugs included in the model to align Medicaid net prices with what certain other countries pay.  CMS also has extended the deadline for drug manufacturers to enter into participation agreements to July 17.  Learn more about CMS’s actions and find links to additional information about the GENEROUS Model and the application process in this CMS news release.
  • CMS’s new data reporting requirements for clinical diagnostic laboratory tests that are not advanced diagnostic laboratory tests, passed by Congress earlier this year, take effect on May 1.  Learn more about those new requirements from this CMS explanation, which includes links to useful resources, and from CMS’s Clinical Laboratory Fee Schedule web page.
  • CMS has sent an informational bulletin to state Medicaid and CHIP officials updating its Supplemental Security Income (SSI) and Spousal Impoverishment Standards for 2026.  Find that bulletin here.
  • CMS has proposed updates for its 2028 Home and Community-Based Services (HCBS) Quality Measure Set for 2028 – a set of nationally standardized quality measures for Medicaid-funded HCBS that is intended to promote more common and consistent use within and across states of nationally standardized quality measures in HCBS programs, create opportunities for CMS and states to have comparative quality data on HCBS programs, and drive improvement in quality of care and outcomes for people receiving HCBS.  Learn more about the data set and the changes CMS proposes from this agency notice.  The deadline for submitting comments is May 28.
  • CMS has asked the Office of Management and Budget (OMB) for permission to introduce a new data collection instrument titled “Administrative Procedures for Chronic and Post-Acute Care Quality Programs.”  The agency states that it intends to use the newly collected data for certain procedural requirements associated with its quality reporting programs (QRPs) and value-based purchasing (VBP) programs.  Learn more about the proposed data collection instrument from this CMS notice.  The deadline for stakeholders to submit comments is May 27.
  • CMS has asked OMB for permission to revise its information collection for the CAHPS (Consumer Assessment of Healthcare Providers and Systems) for MIPS (Medicare Merit-based Incentive Payment System) Survey.  The CAHPS for MIPS survey is used in the Medicare quality payment program to collect data on fee-for-service Medicare beneficiaries’ experiences with care from eligible clinicians participating in MIPS.  Learn more about the changes CMS requests from this notice.  The deadline for stakeholders to submit comments is June 26.
  • CMS has asked OMB for permission to revise its current data collection instrument “CMS HCPCS Modification to Code Set Form,” an HCPCS Level II code set that is used primarily to identify items, supplies, and services not included in the HCPCS Level I Current Procedural Terminology codes, such as ambulatory services and durable medical equipment, prosthetics, orthotics, and supplies when used in the home or outpatient setting as well as certain drugs and biologicals.  Learn more about the changes CMS seeks from this notice.  The deadline for submitting comments is May 26.
  • CMS has fined two Medicare Part D plans for failing to meet their contractual obligations to their members.  Learn more about the circumstances surrounding these fines by going here and scrolling down to the links for actions taken on April 29.
  • CMS has updated its informational booklet on the clinical laboratory fee schedule and reporting private payer data.  Find the updated booklet here.

Department of Health and Human Services

  • HHS’s Health Resources and Services Administration (HRSA) will administer the Rural Hospital Provider Assistance Program for FY 2026.  This program is a new formula grant program authorized under the Consolidated Appropriations Act of 2026.  HRSA has published a notice prior to the publication of the Rural Hospital Provider Assistance Program’s official Notice of Funding Opportunity to give eligible hospitals enough time to prepare and submit applications and for HRSA to process applications for the $25 million that will be distributed among eligible hospitals in FY 2026.  HRSA’s preliminary analysis identified 167 hospitals across 13 states that meet the program criteria.  Based on this analysis, HRSA estimates awarding $24,750,000 to 167 eligible hospitals in the amount of approximately $148,000 per hospital assuming all eligible hospitals apply.  All eligible hospitals must apply for grant funding to receive payment.  Learn more about the program, the eligibility criteria – beds, wage index, and rural status – when to expect publication of the official Notice of Funding Opportunity, and how to apply for funding from this HRSA notice.  The deadline for submitting applications will be July 1.
  • HHS’s Agency for Healthcare Research and Quality (AHRQ) seeks nominations of individuals to serve as members of the U.S. Preventive Services Task Force, which develops evidence-based recommendations on clinical preventive services that help improve health outcomes.  AHRQ is seeking clinicians and researchers with expertise in evidence-based medicine, clinical prevention and primary care, including but not limited to specialties such as cardiology, oncology, ob/gyn, pediatrics, family medicine, and health economics.  Go here to learn more about the task force, the backgrounds sought among potential members, the work involved, and how to submit nominations.  The deadline for submitting nominations is May 23.
  • CMS should strengthen Medicare safeguards to prevent and detect potentially improper payments for virtual check-in and e-visit services, HHS’s Office of the Inspector General (OIG) has concluded after a recent audit to evaluate whether there are vulnerabilities in communication technology-based services that might result in improper payments for virtual care services and opportunities to reduce the risk of improper payments.  Learn more about what the OIG found and its recommendations for improvements from this OIG report.

Medicaid State Plan Amendments

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

  • To Arkansas, to bring the state into compliance with CHIP mental health parity regulations.  The state also added benefits for children enrolled in PASSE and modified benefit limits for occupational, physical, and speech therapy services.
  • To California, making technical edits to the practitioner qualifications for behavioral health treatment services.
  • To California, making technical edits to the durable medical equipment section of the state plan to remove low, outdated monetary thresholds.
  • To Florida, updating outpatient hospital reimbursement.
  • To Missouri, amending its approved Primary Care Health Homes state plan to add a community health worker and an optional behavioral health assistant as members of the care team to be paid under the per member per month payment.
  • To New Jersey, authorizing the state to enter into supplemental rebate agreements on a voluntary basis.
  • To North Dakota, amending the state plan to reimburse therapeutic leave days for psychiatric residential treatment facilities.
  • To North Dakota, amending the state plan to update resident classification requirements and to implement an inflation increase for nursing facility services.
  • To Ohio, amending the state’s alternative benefit plan to reflect that Ohio will no longer exclude Medicaid and Medicare duals from managed care enrollment due to the implementation of the Next Generation MyCare Ohio Plan.
  • To Texas, increasing the wage for personal attendants under Medicaid to an average of $13 an hour and discontinuing the attendant compensation rate enhancement program.
  • To Texas, establishing a rate methodology to equal the skilled nursing facility Medicare rate without therapy components, adjusted using the highest case-mix index, and increasing the wage for personal attendants to an average of $13 an hour.
  • To Utah, amending the state plan with a provision to annually update the base value of licensed beds in nursing facilities by applying an inflation adjustment factor to the prior year’s value.  This amendment also specifies the maximum allowable age of a nursing facility.
  • To Washington, updating the fee schedule effective dates of several Medicaid services.

HHS Newsletters, Reports, and Videos

  • CMS – MLN Connects – April 30
  • HHS – Office of the National Coordinator for Health Information Technology – Last week, ONC held an event it titled “Technology’s Role in Making America Healthy Again:  A Discussion on Mental Health and Substance Abuse Care.”  The event consisted of remarks from HHS Secretary Kennedy and three roundtable discussions on the role of health information technology in advancing progress to improve care for people with substance use and mental health disorders.  HHS has posted videos of those livestreamed events.  They were:

Centers for Disease Control and Prevention (CDC)

  • The CDC announced a backyard poultry-related Salmonella outbreak across 13 states.  Thirty-four individuals have been reported sick and 13 have been hospitalized.  There are no reported deaths.  For more information, see this press release.
  • The CDC reported higher-than-normal emergency room visits for tick bites across the country, except in the south-central U.S.  For more information, see this CDC press release and the CDC’s Tick Bite Tracker.

Food and Drug Administration (FDA)

Following a White House executive order directing HHS to accelerate access to treatments for patients with serious mental illness, the FDA has initiated a series of regulatory actions to support the development of serotonin-2A agonists and related products, a class of perception-altering psychedelic medications.  Those actions include issuing national priority vouchers to companies studying

treatment-resistant depression, psilocybin for major depressive disorder, and methylone for post-traumatic stress disorder; authorizing an early phase clinical study of noribogaine hydrochloride to move forward following an investigational new drug submission; and announcing its intention to release final guidance to provide recommendations to sponsors developing these products.  Learn more from this HHS news release.

Justice Department

The Justice Department and the Drug Enforcement Administration (DEA) have issued an order placing FDA-approved products containing marijuana and marijuana products regulated by a state medical marijuana license in Schedule III of the Controlled Substances Act.  DEA also will hold an administrative hearing beginning on June 29 to address the proposed rescheduling of marijuana.  In issuing the order, the Justice Department explained that these actions are intended to facilitate research on the safety and efficacy of these substances.  Learn more from this Justice Department news release and the order itself.

Stakeholder Events

MACPAC – Commissioners Meeting – May 7

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, May 7.  Go here to register to participate.

HHS Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology/Health Information Technology Advisory Committee – May 7

The Health Information Technology Advisory Committee of HHS’s Office of the Assistant Secretary for Technology Policy will hold its next meeting on Thursday, May 7.  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 September 24 and November 5.

HHS/Administration for Strategic Preparedness and Response – Medical Leadership in Disaster Preparedness and Response Webinar – May 11

HHS’s Administration for Strategic Preparedness and Response (ASPR) will hold a webinar on medical leadership in disaster preparedness and response on Monday, May 11 from noon to 4:30 (eastern).  The conference will bring together individuals who have a medical direction role during disasters to discuss the spectrum of medical leadership responsibilities and some of the specific challenges of the role.  Among the subjects they will address are developing/implementing best practices during a disaster; navigating downtime; using data for action; learning about the new disaster medicine subspecialty; and discovering health care surge tools.  Learn more about the webinar, including continuing medical education credits and how to register to participate, from this ASPR notice.

CMS Center for Clinical Standards and Quality – Quarterly Stakeholder Webinar – May 12

CMS’s Center for Clinical Standards and Quality will hold a quarterly stakeholder webinar on Tuesday, May 12 at noon (eastern).  Agency staff will present an update on its work to strengthen health care quality, safety, and coverage and describe recent policy developments.  Go here to register to participate.

OPTN – National Town Hall Meetings –May 13

The Organ Procurement and Transplantation Network (OPTN) will hold a town hall meeting for members of the community and the public on Wednesday, May 13 at 3:00 (eastern).  During the event, officials will provide updates on the current state of the OPTN and its modernization efforts.  Participants will have the opportunity to submit questions in advance and the session will include a moderated question-and-answer period.  Go here to learn more and to register to participate.

CMS – HCPCS Level II Public Meetings – June 1

CMS will hold its 2026 HCPCS level II public meeting, in person and virtually, on June 1, 2026 at 9:00 (eastern), with an overflow date of Tuesday, June 2, 2026 to be held virtually, if necessary, to discuss CMS’s preliminary coding, Medicare benefit category, and Medicare payment determinations.  Learn more about the meeting, including how to submit questions and comments and register to participate, from this CMS notice.

MedPAC – Commissioners Meeting – September 3-4

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, September 3 and Friday, September 4.  An agenda for the meeting and information about how to participate have not yet been posted; when they are, they will be found here.