The following is the latest health policy news from the federal government for January 11-17.  Some of the language used below is taken directly from government documents.

Congress  

House Budget Committee

Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending by between $5.3 trillion and $5.7 trillion over a period of ten years.  Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending.  The health care cuts the document lists (all figures are ten-year reductions) are:

Medicare

  • introducing Medicare site-neutral outpatient payments – $146 billion
  • reducing Medicare disproportionate share (Medicare DSH) uncompensated care payments – $229 billion
  • reducing Medicare bad debt reimbursement – $42 billion
  • extending the Bipartisan Budget Act of 2013 budget sequestration that included cuts in Medicare spending – $62 billion

Medicaid

  • introducing per capita caps on federal contributions to state Medicaid programs – up to $918 billion
  • reduce the Federal Medical Assistance Percentage (FMAP) share for Medicaid expansion populations – up to $690 billion
  • limiting states’ use of Medicaid provider taxes – $175 billion
  • lowering the floor for FMAP federal Medicaid matching funds – $387 billion
  • reducing special FMAP treatment for Washington, D.C. – $8 billion
  • repealing the American Rescue Plan FMAP incentive – $18 billion
  • introducing a Medicaid work requirement – $120 billion

Affordable Care Act-Related Policies

  • recapturing the excess premium tax credit – $46 billion
  • limiting health program eligibility based on citizenship status – $35 billion
  • repealing the Prevention Public Health Fund – $15 billion
  • making unspecified cost-sharing reductions – $55 billion

Other Provisions

  • repealing unidentified “major” Biden administration health care regulations – $420 billion
  • reinstating changes in the public charge rule introduced in 2019 but repealed in 2021 – $15 billion
  • rescinding all unspent federal COVID-19 money – $11 billion

It is important to note that this document is considered a menu of possible cuts and would require legislation for them to take effect.  Congress will not necessarily pursue all the cuts on this list, questions have already been raised about whether the savings they would produce are as great as anticipated, and there may be cuts not listed that could later become part of policy deliberations.  Learn more from the committee members’ menu of possible cuts.

House Energy and Commerce Committee

As the House Energy and Commerce Committee begins its work, committee leadership has indicated that among the cost-cutting ideas it will consider are pharmacy benefit manager (PBM) reforms and the possible introduction of site-neutral Medicare outpatient payments.  Neither the committee nor its Subcommittee on Health have published any documents addressing these or other possible areas of interest.

House Freedom Caucus

A document posted by the House Freedom Caucus offering its proposals for a potential reconciliation bill includes a provision calling for Medicaid and SNAP work requirements.  Such a provision, the document estimates, would cut federal spending by $120 billion over ten years.  See the caucus document here.

Telehealth Regulations

  • The Drug Enforcement Administration (DEA) has issued a proposed rule addressing special registrations for telemedicine and limited state telemedicine registrations.  The rule would establish three tiers of telemedicine prescribing registration:  one authorizing qualified clinician practitioners to prescribe Schedule III-V controlled substances via telemedicine; a second to authorize qualified, specialized clinician practitioners, such as psychiatrists and hospice care physicians, to prescribe Schedule II-V controlled substances via telemedicine; and a third tier authorizing covered online telemedicine platforms, in their capacity as platform practitioners, to dispense Schedule II-V controlled substances.  The rule would require special registrants to maintain telemedicine registration in every state in which they treat patients.  Learn more from this pre-publication version of the proposed rule.  The deadline for submitting comments will be 60 days after official publication, scheduled for January 17.
  • The DEA and HHS have issued a final rule expanding the ability of qualified providers to prescribe buprenorphine via telemedicine.  Under the new rule, practitioners registered by the DEA may prescribe schedule III-V controlled substances for the treatment of opioid use disorder via a telemedicine encounter, including an audio-only telemedicine encounter.  After a practitioner reviews a patient’s prescription drug monitoring program data for the state in which the patient is located during the telemedicine encounter, the practitioner may prescribe an initial six-month supply of such medications through audio-only means.  Additional prescriptions can be issued under other forms of telemedicine as authorized under the Controlled Substances Act or after a medical evaluation in person.  This regulation also requires pharmacists to verify the identity of patients prior to filling such prescriptions.  Learn more about this authorization of expanded use of telehealth to prescribe buprenorphine from this pre-publication version of the final rule.  The rule will take effect 30 days after its official publication, scheduled for January 17.
  • HHS and DEA have issued a final rule authorizing Department of Veterans Affairs practitioners acting within the scope of their VA employment to prescribe controlled substances via telemedicine to VA patients whom they have not evaluated in person.  VA practitioners are permitted to prescribe controlled substances to VA patients if another VA practitioner has, at any time, previously evaluated the VA patient in person, subject to certain conditions.  This rule is specifically directed at practitioners within the VA health care system.  Learn more from this pre-publication version of the final rule, which is scheduled for official publication on January 17 and will take effect 30 days later.

No Surprises Act

In response to a legal challenge to how health care payers were calculating the qualifying payment amount, or QPA, a key measure for adjudicating payment disputes between health care payers and providers under the No Surprises Act, CMS has issued an FAQ outlining how it intends to proceed in light of the federal court decision.  Included in the FAQ is notice that the agency will extend its current period of enforcement discretion until August 1.  The court decision in the case called for changes in how payers calculate their qualifying payment amount.  CMS will provide similar leeway to providers that billed patients for cost-sharing based on the aspect of the QPA that the court vacated.  Learn more from CMS’s FAQ on its enforcement of No Surprises Act requirements.

Centers for Medicare & Medicaid Services

  • CMS has issued its final HHS Notice of Benefit and Payment Parameters for 2026 that sets standards for the health insurance marketplaces, health insurance issuers, brokers, and agents who connect consumers to Affordable Care Act coverage.  The rule finalizes additional safeguards, beginning in 2026, to protect consumers from unauthorized changes in their health care coverage and includes measures to ensure the integrity of the federally-facilitated marketplaces.  Among other provisions, the rule seeks to prevent unauthorized marketplace activity among agents and brokers; to address allowable cost-sharing reduction loading; to advance health equity and mitigate health disparities; to make it easier for consumers to enroll in and maintain coverage; to increase transparency; to refine the HHS-operated risk adjustment program; and to strengthen the marketplace’s impact on consumers.  Learn more from this CMS fact sheet and the final rule, which takes effect immediately.
  • CMS has published CY 2026 Medicare Advantage payment rates and outlined technical updates designed to keep Medicare Advantage payments up to date.  If finalized, the proposed changes would result in a net increase of 4.33 percent, or more than $21 billion, in payments to Medicare Advantage payments to plans in CY 2026.  Learn more from this CMS news release, an accompanying fact sheet, and its Advance Notice of Methodological Changes for Calendar Year (CY) 2026 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies.  The deadline for submitting comments is February 10 and CMS intends to publish the final regulation no later than April 7.
  • CMS has released its draft CY 2026 Part D Redesign Program Instructions concurrently with the Advance Notice of Methodological Changes for CY 2026 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies.  The draft instructions address changes mandated by the Inflation Reduction Act; the structure of standard Part D benefits, including enrollee obligations; the criteria for creditable coverage; the selected drug subsidy; the regulatory exception for permitting formulary substitution of selected drugs; and more.  Learn more about the draft Part D redesign program instructions from this CMS fact sheet and CMS’s notice to Medicare Advantage organizations, Part D plan sponsors, and other interested parties.  The deadline for submitting comments is February 10 and CMS intends to publish the final regulation no later than April 7.
  • CMS has updated its FAQ on hospital price transparency requirements.  Find the updated FAQ here.
  • CMS has written to state Medicaid and CHIP agencies to provide guidance on implementing the Consolidated Appropriations Act of 2023 requirement that states provide 12 months of continuous eligibility for children under the age of 19 in Medicaid and CHIP effective January 1, 2024.  The letter provides background on the importance of continuous eligibility in preventing interruptions that impede access to health coverage to support better short- and long-term health outcomes and describes policies for implementing continuous eligibility under the 2023 amendments.  It also clarifies which states had to submit Medicaid and CHIP state plan amendments and reminds states that section 1115 demonstration authority also may serve as a mechanism to extend the continuous eligibility period for children beyond 12 months and/or to apply continuous eligibility to adults.  Find the CMS letter here.
  • CMS, in cooperation with HRSA and the CDC, has issued an informational bulletin to the states identifying opportunities for state Medicaid programs to improve HIV prevention, outcomes, and population health in light of recent advances in HIV testing, prevention, care, and treatment.  The bulletin presents updates on clinical guidelines and innovations and summarizes applicable federal requirements and strategies that state Medicaid programs may undertake.  Find that bulletin here.
  • CMS has hired a contractor to develop new measures for children who use home- and community-based services (HCBS) and to maintain CMS’s existing HCBS and long-term services and supports measures for adults and is seeking stakeholders to serve on a technical expert panel and contribute direction to the measure developer during measure development and maintenance.  Panel meetings are conducted virtually and will focus on soliciting review and feedback on prioritization of new measure concepts, re-specification of existing measures, draft measure specifications, and results from alpha and beta testing and public comment.  Learn more about the panel’s work, the background sought among potential participants, the time commitment involved, and how to apply to participate by going here and scrolling down to the link for “Home and Community-Based Services (HCBS) Measures Maintenance and Development.”  The deadline for submitting applications is February 12.
  • CMS reports progress toward its goal of having all people with Traditional Medicare in care relationships with accountability for quality and total cost of care by 2030.  As of January 2025, 53.4 percent of people with Traditional (fee-for-service) Medicare are in an accountable care relationship with a provider.  This represents more than 14.8 million people and marks a 4.3 percentage point increase from January 2024, the largest annual increase since CMS began tracking accountable care relationships.  This includes patients whose providers are in ACOs, including the Medicare Shared Savings Program ACOs, and entities participating in Center for Medicare and Medicaid Innovation accountable care models and models focused on total cost of care, advanced primary care, and specialty care.  Learn more about the increased adoption of ACOs and the contribution of the individual models toward the reported increase in participation from this CMS news release.
  • In a new blog post, CMS’s Center for Medicare and Medicaid Innovation (CMMI) describes how, in addition to introducing new models in pursuit of different objectives, it takes some of it models through multiple iterations, using lessons learned from an originator model, to inform a subsequent, follow-up model with new features in pursuit of a path to what ultimately might be scaled nationally.  Learn more from this CMS blog post.

Department of Health and Human Services

  • HHS has declared a public health emergency in California to aid in the response to the continuing wildfires in Los Angeles County.  Learn more from this HHS news release and this CMS news release.  In addition, find a list of California public health emergency-related documents here and a description of the individual waivers available through CMS here.
  • HHS, the Department of Labor, and the Treasury Department have withdrawn a proposed rule they published last October that would have required coverage of certain preventive services under the Affordable Care Act.  Among other considerations, the proposed rule would have required insurers to cover certain recommended over-the-counter contraceptive items without requiring a prescription and without imposing cost-sharing requirements.  In addition, the proposed rule would have required insurers to cover certain recommended contraceptive items that are drugs and drug-led combination products without imposing cost-sharing requirements unless a therapeutic equivalent of the drug or drug-led combination product is covered without cost-sharing.  Go here to see the agencies’ regulatory announcement of their withdrawal of the proposed rule.
  • HHS has issued an AI strategic plan that establishes both the strategic framework and an operational roadmap for responsibly leveraging emerging technologies to enhance HHS’s core mission.  The plan is built around four goals:  to spur health AI innovation and adoption to unlock new ways to use AI to improve people’s lives; to promote trustworthy AI development and ethical and responsible use to avoid potential harm; to democratize AI technologies and resources to promote equitable access for all; and to cultivate AI-empowered workforces and organizational cultures to enable staff to make the best use of AI.  Learn more from this HHS news release; from CMS’s web page presenting the plan; and from the plan itself.
  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) has released updated national behavioral health crisis care guidance consisting of three documents:  “2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care;” “Model Definitions for Behavioral Health Emergency, Crisis, and Crisis-Related Services;” and a draft “Mobile Crisis Team Services:  An Implementation Toolkit,” which was released for public comment.  The updated national guidance reflects the national transition to the 988 Suicide & Crisis Lifeline in 2022 and other progress and emerging needs related to behavioral health crisis care and provides a framework for transforming behavioral health crisis care systems.  Learn more about the objectives of this undertaking from this HHS news release, which includes a link to the national guidance and the three component documents.
  • HHS’s Office of the Assistant Secretary for Technology Policy (ASTP) has posted its annual interoperability standards advisory reference edition.  This year’s edition includes alignment updates to the administrative and pharmacy sections and smaller updates addressing public health, unique device identification, and admit, discharge, and transfer notifications.  Go here for the 11th annual edition of this reference edition.
  • ASTP has posted a draft of its United States Core Data for Interoperability Version 6.  The draft seeks to advance health data in a way that will benefit users of health IT.  Find the draft here.  The deadline for submitting comments is April 14.
  • HHS’s Office of Information Security and Health Sector Cybersecurity Coordination Center have issued an analyst note about telehealth.  The bulletin describes the uses of telehealth, challenges such as data breaches, ransomware, phishing attacks, and more; presents possible solutions to these challenges; and directs stakeholders to additional resources.  Learn more from this analyst note.
  • HHS has published a report in response to its request for information on consolidation in health care markets.  The report addresses the effects of increasing consolidation in health care markets and the recent influx of private equity and other private investors active in those markets.  Major themes in the report are the perspective that provider consolidation leads to higher prices and less access for patients; that mergers and acquisitions, especially those involving private equity investors, result in process changes and quality reductions; that there is a desire for greater transparency into private equity-led transactions; that physicians who work with private equity forms offer mixed reviews of their experiences; and that people are dissatisfied with private health insurers, especially vertically integrated insurers.  Learn more from this HHS news release and the HHS report “HHS Consolidation in Health Care Markets RFI Response.”
  • HHS’s Health Resources and Services Administration (HRSA) has awarded $60 million in grants to 125 HRSA-funded community health centers that serve nearly 4.2 million people to enable them to expand their hours of operation to improve access to care.  Health centers receiving this new funding will expand their early morning (before work), evening, and weekend hours by an average of 20 hours a week.  Learn more about the new funding and find a link to a list of recipients of the grant funds from this HHS news release.
  • HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) has published a report on the impact of alternative payment models on Medicare spending and quality between 2012 and 2022.  ASPE’s analysis of Center for Medicare and Medicaid Innovation models and the Medicare Shared Savings Program (MSSP) found that they generated gross savings for all beneficiaries in the Traditional Medicare program while demonstrating positive effects on selected quality measures.  Between 2012 and 2022, 19 selected CMMI models generated average annual savings ranging from $23 to $31 per beneficiary per year, amounting to $0.70-$1.0 billion in annual gross savings and total gross savings of $7.7–$11.0 billion between 2012 and 2022.  Between 2012 and 2022, MSSP generated average annual savings ranging from $68 to $94 per beneficiary per year, amounting to $2.1- $2.9 billion in annual gross savings and total gross savings of $23–$31 billion between 2012 and 2022.  Most of the estimated reductions in Medicare spending from CMMI models were attributed to counties that attained or maintained relatively high levels of model penetration over the study period.  Learn more from the ASPE report “The Impact of Alternative Payment Models on Medicare Spending and Quality, 2012-2022.”
  • ASPE has published a report on how states and communities fund behavioral health crisis services and the degree to which Medicaid, Medicare, and commercial insurers are using universal billing codes and paying for behavioral health crisis services to enhance the response for the need for such services.  Learn more from the ASPE report “Behavioral Health Crisis Services:  Insurance Reimbursement.”
  • ASPE has published a report on Medicare Part B enrollee use and spending on biosimilars from 2018 through 2023.  Find it here.
  • HHS’s Office of the Inspector General (OIG) has issued a favorable opinion about a program to provide free access to a pharmaceutical product to patients who meet financial and other eligibility criteria and who do not have adequate coverage for the product.  Find that advisory opinion here.
  • The HHS OIG has updated its work plan for January audits and reviews.  Find that update here.

HHS Newsletters and Reports

Centers for Disease Control and Prevention

The CDC, Department of Agriculture, and the Department of the Interior have released a national framework for addressing zoonotic diseases and to advance public health preparedness.  The plan seeks to improve the health of humans, animals, and the environment by recognizing their close connections.  It seeks to present a framework for navigating health threats shared between people and animals, such as COVID-19, mpox, avian influenza, and Ebola.  Learn more from this CDC news release and the document “National One Health Framework to Address Zoonotic Diseases and Advance Public Health Preparedness in the United States.”

Occupational Safety and Health Administration

In mid-2021, during the COVID-19 public health emergency, OSHA issued an emergency temporary standard, as proposed rulemaking, to protect workers in health care settings.  With the end of that emergency, OSHA has announced that it is terminating the rulemaking via this proposed rule because the public health emergency is over and any continuing risk from COVID-19 or other coronavirus hazards faced by health care workers would be better addressed in future rulemaking addressing infectious diseases more broadly.  Find OSHA’s explanation in this regulatory announcement.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC has published an issue brief that uses data from the Postpartum Assessment of Health Survey to analyze differences in reported health status, access to care, service utilization, and overall health between postpartum Medicaid beneficiaries with and without mental health conditions.  It also compares individuals with mental health conditions by payer type.  Find the report here.

Stakeholder Events

MedPAC – Commissioners Meeting – January 17

MedPAC’s commissioners are holding their latest public meeting virtually on Thursday, January 16 and Friday, January 17.  Go here to see the meetings’ agenda and for information about how to participate.

MACPAC – Commissioners Meeting – January 23-24

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, January 23 and Friday, January 24.  Go here to find the meeting’s agenda and for information about how to participate.

CMS – Rural Health Open Door Forum – January 23

CMS will hold an open-door forum for rural health care providers and organizations on Thursday, January 23 at 2:00 (eastern).  Go here to register to participate.