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

ASH Advocacy

 

This week, the Alliance of Safety-Net Hospitals (ASH) urged representatives to co-sponsor and support the passage of H.R. 10770, the 340B Rebate Model Delay Act.  Introduced by Representatives Bob Bresnahan (R-PA), Debbie Dingell (D-MI), Tracey Mann (R-KS), and Lois Frankel (D-FL), the bill would impose a two-year moratorium on CMS’s 340B Rebate Model Pilot Program.  See the message to Congress here.

Congress

  • Senate Finance Committee Ranking Member Ron Wyden (D-OR) released a Request for Information (RFI) titled “Delivering An Affordable Home Care Guarantee for American Families,” seeking feedback on policy proposals aimed at making home care affordable and accessible, especially for those with disabilities and seniors; improving the quality of care in nursing homes; and strengthening the long-term care workforce. Written comments are due to homecare@finance.senate.gov no later than December 18, 2026.  For more information, see the press release here and the RFI here.
  • Senate Finance Minority Committee Members Ron Wyden (D-OR), Elizabeth Warren (D-MA), and Raphael Warnock (D-GA) released an interim report examining several major contractors that build and manage state Medicaid eligibility and enrollment systems, arguing that these firms could benefit financially from Medicaid coverage reductions while states implement H.R. 1 policy changes. The investigation focused on Maximus, Gainwell, General Dynamics Information Technology, Conduent, and Deloitte.  According to the report, none of the companies provided historical data on how many individuals their systems determined to be ineligible for Medicaid coverage, and none offered detailed information about how they test their systems for accuracy.  For more information, see the Ranking Member’s press release here and the report here.
  • A bipartisan group of Senators wrote a letter to Acting Commissioner of Food and Drugs, Kyle Diamantas, urging the U.S. Food and Drug Administration (FDA) to work closely with U.S. Customs & Border Protection (CBP) and other law enforcement agencies to take illicit drugs off the market and hold online drug and active pharmaceutical ingredient (API) vendors accountable. For more information, see the letter here and Senator Jim Banks’ (R-IN) press release here.
  • Both chambers of Congress will reconvene on November 9 after the mid-term elections. Upon their return, one of their priorities will be advancing a government funding package because the current continuing resolution (CR) expires on December 11. 

The White House

 

Led by First Lady Melania Trump, the White House issued an executive order titled “Advancing Women’s Health to Improve Outcomes in All Phases of Life,” which directs the U.S. Department of Health and Human Services’ (HHS) National Institutes of Health (NIH) to establish a new Women’s Health Division.  The new division aims to advance research into conditions that uniquely or disproportionately affect women, strengthen accountability in federally funded research, and accelerate the translation of scientific discoveries into prevention, diagnosis, treatment, and clinical care.  For more information, see the executive order here, the White House press release here, and the HHS press release here.

Centers for Medicare & Medicaid Services (CMS) 

  • In accordance with the Consolidated Appropriations Act of 2026, CMS issued a proposed rule to implement adjustments to Medicare Part D cost-sharing reductions for low-income individuals, the Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act, and Pharmacy Benefit Manager (PBM) accountability. Public comments are due December 15, 2026 at 5 p.m. eastern time (ET).  For more information, see the CMS press release here, fact sheet here and the Federal Register notice here.
  • CMS has asked OMB for permission to revise its information collection requirements related to the Medicare Modernization Act’s (MMA) Phased-Down State Contribution (PDSC) process, which helps calculate the share of prescription drug costs that states continue to fund for Medicaid beneficiaries who became eligible for Medicare Part D. CMS emphasized the importance of receiving timely and accurate dual-eligibility data from states, noting that daily data exchanges help ensure beneficiaries are enrolled in the appropriate Medicare drug plans and receive Part D low-income subsidy assistance without delays.  Public comments on the proposal are due by December 15, 2026.  For more information, see the Federal Register notice here.
  • CMS, the Small Business Administration (SBA), and Take Command, the first provider of Individual Coverage Health Reimbursement Arrangements (ICHRAs), convened in Ohio, bringing together policymakers, industry experts, and Ohio businesses for a conversation about CHOICE Arrangements. The program allows employers to provide employees with a tax-advantaged contribution toward individual health coverage instead of a traditional group health plan.  Employees can use the contribution toward qualifying individual coverage based on their own healthcare needs and preferences.  For more information about the meeting see the press release here and the CHOICE Arrangement website here. 
  • CMS and the U.S. Department of Labor announced that Amazon, Axon Enterprise, Google, Meta, and Oracle have signed a statement of support committing to make technical solutions and other capabilities developed through the 2025 Prior Authorization Pledge available to employers that sponsor self-funded health plans. For more information, see the press release here and the Employer Statement of Support for Electronic Prior Authorization here. 

Department of Health and Human Services (HHS)

  • HHS launched the Kidney Care National Plan, a department-wide strategy aimed at preventing kidney failure, improving dialysis care and expanding patient choice, and reforming transplantation. For more information, see the Office of the Assistant Secretary for Planning and Evaluation (ASPE) Kidney Care National Plan here, the HHS fact sheet here, and the HHS press release here.
  • HHS’s HRSA announced seven awards through its Sickle Cell Disease Regional Care Excellence (SoRCE) Program. The funding will help establish Regional Coordinating Hubs to help individuals with sickle cell disease access care and community services.  For more information, see the press release here and the SoRCE webpage here for the list of FY 2026 award recipients.
  • HHS announced the 2026 Update to the “National Plan to Address Alzheimer’s Disease and Related Dementias,” a department-wide effort to guide federal action on dementia risk reduction, research and innovation, care, and support for those with dementia and their families. For more information, including the National Plan’s four new goals, see the press release here.

340B

 

In response to a lawsuit filed by a coalition of hospitals and hospital associations challenging HHS and the Health Resources and Services Administration’s (HRSA) planned implementation of the 340B Rebate Model Program, AbbVie and its Pharmacyclics unit, Bristol Myers Squibb, and Boehringer Ingelheim filed a motion to intervene on October 14, followed by a separate motion from PhRMA on October 15 in support of the rebate model.  The motions contend that drug manufacturers have incurred millions of dollars in losses due to alleged duplicate discounts.  Beginning January 1, the 340B Rebate Model will replace discounts to qualified institutional providers under the 340B program with post-purchase rebates for 21 prescription medicines sold by 10 drug companies.  Learn more from the lawsuit filed to prevent implementation of the 340B Rebate Model Program.

Fraud, Waste, and Abuse

  • As head of the White House Task Force to Eliminate Fraud, Vice President J.D. Vance called on government officials to join his pledge to “protect vulnerable Americans, keep taxpayer-funded benefits for Americans only, stop fraud before the money goes out, and hold fraudsters accountable.” For a full list of those who have made a pledge, see the White House press release here and the Vice President’s announcement here.
  • CMS has determined that five existing Independent Dispute Resolution (IDR) entities have met the minimum qualifications to move to the Petition Period in the Independent Dispute Resolution Entity recertification process for October 16, 2026, through October 22, 2026. The five entities in the petition period are Maximus Federal Services, Inc.; ProPeer Resources LLC; C2C Innovative Solutions, Inc.; Medical Evaluators of Texas ASO, LLC; or Federal Hearings and Appeals Services, LLC.  Stakeholders have until October 22, 2026 to submit a petition for the denial of an IDR entity’s recertification. The Departments are accepting and reviewing applications on a rolling basis and will post additional organizations for a petition period once their application has been reviewed and meets the minimum qualifications.  For more information, including a link to the petition form, see the IDR webpage here.
  • CMS issued a notice of a computer matching program between CMS and the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA). The purpose of the matching program is to identify beneficiaries enrolled in both Medicare and VHA health care and to identify medical claims for which both agencies made payment for the same health care services.  Under this agreement, the VHA will provide CMS with a finder file on a recurring basis, of all Veteran beneficiaries enrolled in VHA health care that CMS will use to identify dually enrolled beneficiaries.  CMS and VHA will use the results of the matching program to recover duplicate payments, improve payment accuracy, and identify potential fraud, waste, and abuse.
  • The White House and DOJ announced a $25 million initiative that would pay out cash for people who tip off the federal government about fraudsters through fraud.gov. The Fraud Whistleblower Incentive Program will offer a one percent commission on successful convictions, with particular interest in hospice, home health care, day care, and special services fraud.  See the DOJ press release here.
  • The Department of Treasury issued a notice of information collection and request for comment on its referral portal to report suspected fraud, waste, abuse, improper payments, misuse of Federal funds, and related misconduct at fraud.gov. Comments must be received by December 21, 2026.  For more information, see the Federal Register notice here.
  • The Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) updated its “Health Care Fraud Self-Disclosure” protocol. The form to voluntarily disclose is intended for health care providers, health care suppliers, and people subject to OIG’s civil monetary penalties (CMP) authorities.  For more information, see the updated protocol here and the OIG here.
  • HHS’ OIG updated its “Fraud Risk and Heightened Scrutiny” report for Fiscal Year (FY) 2026 Q1-Q4. When settling a health care fraud case, OIG will pursue one of the following approaches 1) exclusions, 2) heightened security, 3) corporate integrity agreements (CIAs), 4) no further action, or 5) self-disclosure.  See the report here. 
  • CMS announced that it will defer $1.2 billion in federal Medicaid payments to California. For more information, including a recording of the remarks made by CMS Administrator Dr. Mehmet Oz, see a C-SPAN recording here.

Rural Health Transformation Program Funding 

 

In the past week CMS announced that it has awarded Rural Health Transformation Program money to the following states:

  • Alaska, nearly $249 million to expand maternal and child health services, strengthen the rural health workforce, bring new technology to village clinics, and improve access to care in communities statewide.
  • Maryland, more than $16 million for rural healthcare workforce training and retention.
  • Mississippi, $23 million to strengthen Mississippi’s rural healthcare workforce and expand access to emergency mental health services.
  • Montana, $3.63 million to expand community integrated health (CIH) services.
  • New Hampshire, $11 million to strengthen rural EMS and expand mobile healthcare.
  • Ohio, $92 million to help rural providers connect patients to coordinated, high-quality care and bring essential health services closer to home.
  • Texas, $8 million to support chronic disease prevention, improved health outcomes, recruitment and retention of healthcare professionals, and medical equipment and facility improvements to expand access to high-quality care. 

Medicaid State Plan Amendments

 

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

  • Florida, updating FQHC and Rural Health Clinic reimbursement rates.
  • Florida, updating County Health Department reimbursement.
  • Louisiana, removing a past policy sunset date to bring the state plan into compliance with the Consolidated Appropriation Act of 2023.
  • Massachusetts, to update the Outpatient Hospital services reimbursement.
  • Massachusetts, to update the Payment Methodologies for Pre-Release Services.
  • Nevada, introducing a bundled rate for a new service: Assertive Community Treatment to assist individuals with serious mental illness and/or serious mental illness with co-occurring disorders.
  • New York, to allow medically fragile young adults who reside in pediatric specialized nursing facilities to remain at such facilities after reaching the age of twenty-one and until they reach the age of thirty-six.
  • Ohio, to add attachment 4.30 to outline Ohio’s process for monitoring noncompliance and determining the most appropriate corrective actions for psychiatric hospitals, managed care organizations, and primary care case managers.
  • South Carolina, to reimburse state government owned Psychiatric Residential Treatment Facilities (PRTF) services at a rate of $1330 per day for services incurred on or after January 1, 2026.
  • Utah, to update the payment structure for Medicaid providers for outpatient services in Cache County.

Health Policy Newsletters, Reports, and Videos

  • CMS – MLN Connects – October 22
  • CMS – “CMS EPCS Prescriber Portal Demonstration” – October 17 video
  • HHS – “War on Fraud Mini Doc” – October 21 video
  • HHS/Office of the Inspector General (OIG) –
  • HHS/ Office of the Assistant Secretary for Planning and Evaluation (ASPE) –
    • “Strategies to Improve the Ratio of Homes Available to Children in Foster Care: Findings from Five States” – October 16 report
    • “A Home for Every Child Case Studies: Briefs from Five States with Some of the Highest Home-to-Child Ratios” – October 16 report
    • “Financing Medicaid Through Provider Taxes on Hospitals: Spillover Effects on Employment-Based Coverage Premiums” – October 20 report
    • “Health and Economic Benefits Associated with Increased Kidney Transplantation Following the Advancing American Kidney Health Initiative in 2019” – October 20 report
    • “Kidney Care National Plan” – October 20 report
    • “Project Update: Child Welfare and Health Infrastructure for Linking and Data Analysis of Resources, Effectiveness, and Needs Initiative” – October 20 report
  • Government Accountability Office (GAO) –
    • “Research Security: NIH Action Needed to Strengthen Foreign Interference Risk Management” – October 16
    • “Private Health Insurance: Market Concentration in 2024 Was Generally Higher Than in 2011” – October 16 

Food and Drug Administration (FDA) 

  • The FDA issued a final rule to establish a framework for how drug companies can develop, distribute, and label apps used alongside their prescription medicines. The final rule clarifies when app content is treated as FDA-required labeling versus promotional labeling, when an app should be referenced in a drug’s official prescribing information, and what companies should submit to FDA when they distribute app content to users.  The guidance also identifies two categories of companion software; apps connected to a medical device and standalone apps.  For more information, see the final guidance in the Federal Register here and the FDA press release here. 
  • The FDA published a final guidance titled “New Dietary Ingredient (NDI) Notifications and Related Issues; Identity and Safety Information About the NDI,” which is intended to help manufacturers and distributors of NDIs regarding the identity and safety information that should be included in a new dietary ingredient notification (NDIN). For more information, see the Federal Register notice here and the FDA constituent update here. 
  • The FDA published its “Generic Drug User Fee Amendments (GDUFA) Science and Research Priority Initiatives for Fiscal Year (FY) 2027,” outlining eight research priorities to address scientific and regulatory challenges facing the generic drug industry and support the agency’s generic drug program. The initiatives aim to advance the development of generic medications, streamline regulatory assessments, and lower the cost of prescription drugs.  For more information, see the agency’s white paper here. 

The VA shared that more than 300,000 new Veterans have enrolled in VA health care so far in 2026 as part of a larger effort to make VA benefits better and more accessible.  For more information, see the press release here. 

The Medicaid and CHIP Payment and Access Commission (MACPAC) 

 

MACPAC submitted a comment letter to the Centers for Disease Control and Prevention (CDC) in response to the agency’s notice on the systemic redesign of the National Health Interview Survey (NHIS) to be implemented in 2028, published on August 20, 2026.  MACPAC encourages the CDC to (1) retain the historical and consistent introductory text to the health insurance questions and the separate response categories for Medicaid and CHIP to permit consistent identification of coverage type over time; (2) rescind proposed changes to key adult measures that would prevent year-over-year trend analysis; (3) restore the questions pertaining to the use of services by children with disabilities; and (4) maintain the questions about adult employment that will be important for understanding the populations affected by new Medicaid policies established in the 2025 Budget Reconciliation Act.  For more information, see the MACPAC letter here. 

Stakeholder Events 

 

CMS and SAMHSA – National Technical Assistance Center (NTAC) Learning Collaborative (LC) Series 2: Strengthening the Behavioral Health Crisis Continuum of Care – October 28

CMS and SAMHSA will hold a webinar on LC Series 2 to support states in strengthening key components of the behavioral health crisis continuum of care. Through expert-informed content, facilitated discussion, and peer-to-peer exchange, participating state Medicaid agencies will have an opportunity to convene on a monthly basis (from November 2026 through June 2027) to share implementation experiences, explore promising approaches, and identify strategies that can be adapted within their own systems. Go here to register to participate. 

MACPAC – Commissioners Meeting – October 29-30

MACPAC’s commissioners will hold their next public meeting on Thursday, October 29 and Friday, October 30.  Go here to register to participate.

MedPAC – Commissioners Meeting – November 5-6

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, November 5 and Friday, November 6.  An agenda for the meeting and information about how to participate have not yet been posted; when they are, they will be found here.

CMS – Healthcare Common Procedure Coding System (HCPCS) Level II Public Meeting – November 11-12

CMS will hold its second biannual Healthcare Common Procedure Coding System (HCPCS) Level II public meeting of 2026 on Monday, November 2 and Tuesday, November 3 (if necessary) to discuss the CMS preliminary coding, Medicare benefit category, and Medicare payment determinations, if applicable, for new revisions to the HCPCS Level II code set for non-drug and non-biological items and services.  Find the meeting’s agenda and learn more about how to speak at the conference, submit comments, and register to participate either virtually or in person in this CMS announcement. 

CMS – 2026 CMS National Provider Enrollment Conference – November 18-19

CMS will hold a national provider enrollment conference on Wednesday, November 18 and Thursday, November 19 in Kissimmee, Florida.  The event will provide direct access to the staff responsible for shaping and administering Medicare provider enrollment.  Through keynote presentations, panel discussions, interactive Q&A sessions, and expert-led training, participants will gain insight into enrollment policy, program integrity initiatives, compliance requirements, operationally friendly best practices, and upcoming changes affecting the Medicare provider enrollment landscape.  Learn more from this CMS conference notice.

HHS/Office of the Assistant Secretary for Planning and Evaluation – Physician-Focused Payment Model Technical Advisory Committee Meeting – December 8-9

HHS’s Physician-Focused Payment Model Technical Advisory Committee (PTAC) will hold a public meeting on Tuesday, December 8 and Wednesday, December 9 at 9:00 (eastern).  An agenda has not yet been posted.  Go here to learn more about the meeting and how to participate in person or virtually.