Federal Health Policy Update for January 22

The following is the latest health policy news from the federal government for January 16-22. Some of the language used below is taken directly from government documents.

ASH Advocacy

In a letter to House and Senate Appropriations Committee leaders, ASH urged those officials to support passage of the health care extenders included in the recently proposed FY 2026 Consolidated Appropriations Act.

Specifically, ASH encouraged the congressional leaders to support provisions in that bill that would extend current Medicare telehealth flexibilities through the end of 2027; eliminate Medicaid disproportionate share hospital payment cuts (Medicaid DSH) for FY 2026 and FY 2027; extend authorization for the Medicare Acute Hospital Care at Home program through 2030; and delay expiration of the Medicare Low-Volume Hospital Program until the end of 2026.

Learn more from ASH’s letter to congressional leaders.

Congress

The House today passed an Appropriations Committee FY 2026 partial spending proposal that includes a Labor, Health and Human Services, Education, and Related Agencies bill. Policy highlights include:

Telehealth. The bill would extend the major Medicare telehealth flexibilities and the waiver of periodic in-person visits for mental health telehealth services through the end of 2027.
Medicaid DSH. The bill would cancel the FY 2026 and FY 2027 cuts of $8 billion a year and leave just one year, FY 2028, with an $8 billion reduction in Medicaid disproportionate share (DSH) allotments.
Medicare Acute Hospital Care at Home program. The bill proposes extending the program through September of 2030.
Medicare low-volume hospital program. The bill would extend the program’s expiration until the end of 2026.
Medicare dependent hospital program. The bill proposes extending the program through 2026.
Graduate medical education (GME) payments for health centers with teaching programs. The bill appropriates funding for payments for eligible teaching health centers through FY 2029.
Geographic Practice Cost Index (GPCI). The bill would extend the 1.0 floor on the work GPCI through January 1, 2027.
Medicare Advantage. The bill would require accuracy in Medicare Advantage provider directories.
The Medicare Diabetes Prevention Program. The bill would permit virtual-only providers to participate in this program through the end of 2029.
Health insurance premium tax credits. The bill does not extend the now-expired Affordable Care Act enhanced health insurance premium tax credits.
NPIs. The bill calls for establishing separate Medicare identification numbers – NPIs – for all hospital off-campus outpatient departments.
Cardiopulmonary rehabilitation services. The bill would authorize the provision of outpatient cardiopulmonary rehabilitation services through audio and video real-time communication through the end of 2027.

The legislation calls for paying for these provisions through extensive PBM reform and by extending the current two percent Medicare sequestration through the first five months of FY 2033.

Minutes ago the House passed the bill by a vote of 341 to 88. The Senate is now expected to vote on the measure when it returns to Washington next week. If the Senate passed the bill it would go to the president for his signature.

Bill for Safety-Net Hospitals

Representatives David Valadao (R-CA) and Lori Trahan (D-MA) have reintroduced H.R.7145, the “Reinforcing Essential Health Systems for Communities Act.” This bipartisan legislation would enable hospitals to qualify as an “essential health system” if they meet the following standards:

It participates in Medicare’s primary hospital payment program.
It is operated by a government entity or is a private, non-profit hospital.
It meets at least one of the following criteria:
Serves a high number of low-income patients: at least 35 percent of its patients are low-income, based on Medicaid coverage and Medicare patients with limited incomes.
Provides a significant amount of unpaid care:  at least 0.05 percent of all unpaid hospital care nationwide, placing it among the hospitals that shoulder the greatest burden of uncompensated care in the country.
Ranks among its state’s leading safety-net hospitals and in the top 16 percent in its state for serving vulnerable patients and providing unpaid care. This seeks to ensure that hospitals in rural areas or states with smaller Medicaid populations are not excluded.
It has maintained the above criteria in two out of the last three years.

Hospitals would retain eligibility for five years after receiving the essential health system designation.

The measure has five co-sponsors from both sides of the political aisle. See the bill’s press release here and find the bill text here.

Centers for Medicare & Medicaid Services

CMS estimates that the Medicare fee-for-service program made $28.83 billion in improper payments in FY 2025, representing 6.55 percent of those payments. Such improper payments can result from inadequate documentation as well as fraud and abuse, the agency explained. Learn more about improper payments associated with other aspects of the Medicare program, with Medicaid, with the Children’s Health Insurance Program (CHIP), and with premium tax credits for Affordable Care Act health insurance marketplace policies and how these figures compare to findings from past years in this CMS fact sheet.
Section 50324 of the Bipartisan Budget Act of 2018 expanded access to telehealth services for fee-for-service Medicare beneficiaries assigned to applicable accountable care organizations (ACOs) starting January 1, 2020 and established various terms for financial risk for participating ACOs. The law also required CMS to conduct a study on implementation of this provision, analyzing the spending and utilization of these telehealth services. CMS has now submitted that report to Congress along with recommendations for legislative and administrative action. Learn more from the CMS report “Providing Accountable Care Organizations the Ability to Expand the Use of Telehealth.”
CMS has added 18 items to its Master List of DMEPOS Items Potentially Subject to Conditions of Payment. Go here to learn more about the master list and the update.
To prepare for the upcoming electronic clinical quality measure (eCQM) data submission deadline of March 2, 2026, CMS’s Electronic Clinical Quality Improvement Resource Center has asked providers to review their Quality Reporting Document Architecture (QRDA) Category I files; follow the technical specifications outlined by the eCQI Resource Center; and review their measure data results in CMS’s Hospital Quality Reporting System before attesting that the information is accurate. For more information and links to the appropriate resources, see this resource center announcement.
CMS has established a new “Medicare Wellness Visits” web page. Find it here.
CMS has posted new resources for its Home Health Value-Based Purchasing Model (HHVBP). Learn about those resources here.
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.)

Department of Health and Human Services

HHS’s Advanced Research Projects Agency for Health (ARPA-H) has announced a new research and development funding opportunity through its Agentic AI-Enabled Cardiovascular Care Transformation (ADVOCATE) program. This program seeks to develop the first FDA-authorized, agentic AI technology that can provide 24/7 specialty care for the deadliest chronic disease in the U.S. The agency envisions such technology serving as a clinician extender that patients engage with at all times, keeps a close eye on their heart health, and provides access to personalized information and actions, all of which can help them live long and well with advanced heart disease.   Learn more from this ARPA-H news release; the program’s web page; and this funding notice.

HHS Office of the Inspector General (OIG)

In a new report, HHS’s OIG describes the top management and performance challenges facing HHS, including sections on financial integrity, Medicare and Medicaid, public health, beneficiary safety, and cybersecurity. Find the report here.
HHS’s OIG has submitted its fall semi-annual report to Congress. The report describes the significant risks, problems, abuses, deficiencies, remedies, and investigative outcomes in the administration of HHS programs and operations that the OIG identified and disclosed during the semi-annual reporting period from April 1 to September 30, 2025. Find the report here.
The OIG has issued a favorable opinion about a proposal by a manufacturer of a clinical laboratory test for colorectal cancer screening to waive any applicable cost sharing for certain commercially insured patients who receive its colorectal cancer screening test. Find the opinion here.
The OIG has posted a video explaining its advisory opinion process. Find it here.

Medicaid State Plan Amendments

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

To Texas, updating the state’s Medicaid plan to reflect the permanent federal requirement for coverage of medication-assisted treatment for opioid use disorder.

To Louisiana, revising personal care services fee schedules and fee-for-service reimbursement rates and adding specific language regarding wage floor and pass-through requirements for long-term personal care service providers.

To Delaware, removing the September 30, 2025 sunset date for the medication-assisted treatment benefit and making that benefit permanent.

To Virginia, removing the September 30, 2025 sunset date for the medication-assisted treatment benefit and making that benefit permanent.

To Massachusetts, extending Medicaid coverage of substance use disorder treatment and managed care medical loss ratio provisions in the Consolidated Appropriations Act of 2024.

To Washington, D.C., carving out selected drugs from managed care and transitioning their reimbursement to a fee-for-service model at 100 percent of the actual acquisition cost.

To California, removing the requirement that alternative birth centers, also known as freestanding birth centers, be comprehensive perinatal services program providers.
To Kansas, removing the end date for coverage of medication-assisted treatment in accordance with the Consolidated Appropriations Act of 2024.

HHS Newsletters, Reports, and Videos

CMS – MLN Connects – January 22
Agency for Healthcare Research and Quality – AHRQ News Now – January 20
Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth announcements – January 21

Centers for Disease Control and Prevention (CDC)

The CDC reported that alcohol‑related emergency department visits rose significantly from 2003–2004 to 2021–2022. During this period, visits involving alcohol‑specific diagnoses increased 75 percent among men and 71 percent among women. For more information, see the Health E-States January 2026 report here.
Between August 2024 and August 2025, the CDC reported an estimated 24 percent decline in overdose deaths nationwide. Notably, 45 states experienced year-over-year reductions. Find additional data here.
The CDC issued a health alert about recent New World screwworm animal cases in northern Mexico territories that border Texas. The advisory seeks to increase awareness of the outbreak but there have been no infestations reported in the U.S. as of January 20. View the advisory here.
The CDC has posted a notice expressing its intention to initiate round 8 of the National Center for Health Statistics (NCHS) Rapid Surveys System, which was launched in 2023 to collect data about the health of the population of the U.S. The overall survey has three major goals: (1) to provide the CDC and other partners with time-sensitive data of known quality about emerging and priority health concerns; (2) to use these data collections to continue NCHS’s evaluation of the quality of public health estimates generated from commercial online panels; and (3) to improve methods to communicate the appropriateness of public health estimates generated from commercial online panels. Round 8 will include content on artificial intelligence and help-seeking behaviors and selected content from the National Survey on Drug Use and Health, including substance use prevalence, risk perception of certain substance use, recovery from drug and alcohol use and mental health problems, and suicidal thoughts, plans, and attempts. Learn more about the survey, the information the CDC will seek, and the anticipated time commitment from this CDC notice.

Medicare Payment Advisory Commission (MedPAC)

MedPAC held its latest virtual public meetings on Thursday, January 15 and Friday, January 16.  During the two-day session, commissioners received briefings and engaged in in depth discussions on a wide range of Medicare policy issues. The agenda for the meetings included the following topics:

assessing payment adequacy and updating payments: physician and other health professional services
assessing payment adequacy and updating payments: hospital inpatient and outpatient services assessing payment adequacy and updating payments: skilled nursing facility services; home health agency services; inpatient rehabilitation facility services; outpatient dialysis services; and hospice services
mandated report: The impact of recent changes to the home health prospective payment system
analyzing recent increases in Part D bids
Medicare Part D: status report
ambulatory surgical centers: status report
the Medicare Advantage program: status report
mandated report: dual-eligible special-needs plans

MedPAC adopted the following recommendations to Congress for 2027 Medicare rates:

hospital inpatient and outpatient rates – an increase by the amount currently provided for by law
physician and other provider rates – an increase by the amount currently provided for by current law plus 0.5 percent
skilled nursing facilities – a 4 percent reduction
inpatient rehabilitation facilities – a 7 percent reduction
home health services – a 7 percent reduction hospice services – no change in rates

MedPAC also reiterated its past call for implementation of its Medicare Safety-Net Index (MSNI), with $1 billion added to the MSNI pool and for ambulatory surgical centers to collect and submit cost data.

Go here for detailed summaries of the issues, key discussion points, and links to all presentations delivered by MedPAC staff and find transcript of the two-day meeting here.

Government Accountability Office (GAO)

At a time when the country’s organ transplantation program is undergoing modernization and change, the GAO has published a report calling on HHS to develop and implement plans to address the weaknesses in the current system that the GAO and others have identified. Learn more from the GAO report “Organ Transplantation: HHS Action Needed to Improve Lifesaving Program.”

Stakeholder Events

HHS/Administration for Strategic Preparedness and Response – Health Care and Public Health Preparedness for Mass Gatherings Webinar – January 27

HHS’s Administration for Strategic Preparedness and Response (ASPR) will hold a webinar on health care and preparedness for mass gatherings on Tuesday, January 27 at 2:30 (eastern). The purpose of the webinar is to help health care organizations and local, state, and federal authorities anticipate the public health and medical issues presented by mass gatherings and to help them prepare adequately for a range of response operations. Learn more about the webinar from this ASPR notice, which includes information about the issues to be discussed and the speakers and a link to register to participate. Space is limited so ASPR encourages early registration.

CMS – LEAD Model Webinar – January 29

CMS will host a webinar at 2:00 (eastern) on Thursday, January 29 to discuss the goals of its LEAD (Long-term Enhanced ACO Design) model, participation options, eligibility, and payment methodology. Learn more about the LEAD Model from the program’s web page and go here to register to participate in the webinar.

MACPAC – Commissioners Meeting – January 29-30

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, January 29 and Friday, January 30. An agenda is not yet available but go here to register to participate.

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.

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.

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 participate from this CMS announcement.

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