Don’t Miss:

  • 340B data reporting requirements for Medicare Part D claims data – repository opens October 1
  • CMS permanently permits providers to deliver telehealth from home without listing home address on Medicare enrollment application

The following is the latest health policy news from the federal government for August 28-September 3.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services (CMS)

  • CMS is preparing to launch a new Medicare Part D Claims Data 340B Repository on October 1.  The 340B data repository will be a centralized, federally managed information system that will collect, store, and process specific claim-level utilization data for prescription drugs dispensed under the Medicare Part D benefit that also are subject to discounts through the 340B Drug Pricing Program.  The repository will support implementation of the Medicare Prescription Drug Inflation Rebate Program, which was mandated by the Inflation Reduction Act of 2022 and requires the federal government to exclude drug sales that receive a 340B discount from the calculations made to determine manufacturers’ inflation-based rebates.  Authorized users – 340B-covered entities, third-party administrators, and their designated reporting partners – will submit distinct, auditable data elements directly to the repository.  The repository will be launched on October 1 with a voluntary testing period designed to give safety-net providers an opportunity to test their reporting mechanisms and refine the accuracy of the data they submit.  CMS has formally proposed a regulatory transition that would make data submission to the repository mandatory for 340B-covered entities starting on January 1, 2027.  Information housed by the system will be confidential and not shared with external third parties, drug manufacturers, and commercial Part D plan sponsors.  Learn more about the program by going here and scrolling down to “Medicare Part D Claims Data 340B Repository” and from a new CMS fact sheet and FAQs that address data submission requirements, implementation time frames, and more.
  • CMS has made permanent a change in telehealth policy previously introduced as a new flexibility during the COVID-19 public health emergency:  it is now permanently permitting providers to deliver telehealth services from their homes without listing their home address on their Medicare enrollment. Learn more about the policy and find examples of scenarios that reflect this policy change in the updated CMS document “Understanding Telehealth and Teleradiology Enrollment.”
  • CMS has posted a bulletin reminding providers that it has determined that non-invasive biomarker screening tests are appropriate for colorectal cancer screening based on specific criteria as of June 8, 2026.  Find that bulletin here.
  • CMS has added information on prescription drug coverage to its provider-focused fact sheet “Original Medicare vs. Medicare Advantage.”  Find the updated fact sheet here.
  • CMS is offering web-based training that provides an overview of Chapter 2 of the Resident Assessment Instrument (RAI).  The course reviews RAI requirements for OBRA and prospective payment system assessments, including assessment types, timing and scheduling requirements, discharge assessment determination, interrupted stay considerations, and combined assessments.  Learn more from CMS’s Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Training web page (and scroll down to “Updates”).
  • CMS reports that it has prevented $1.6 billion in fraudulent Medicare laboratory payments since the beginning of 2025.  According to the agency, the savings in fraudulent payments were the result of its use of advanced analytics, including artificial intelligence (AI) and machine-learning models, to mine Medicare fee-for-service claims in search of unusual billing patterns and other indicators of potential fraud, waste, or abuse.  Learn more about the types of payments CMS reports preventing from this CMS news release.
  • CMS has added the following item to its Quality Payment Program resource library.  (Note:  clicking this may give a prompt to download a file that may be a zip file.)

White House

The White House has announced agreements with nine pharmaceutical companies to bring prescription drug prices for Americans in line with the lowest prices paid by consumers in other developed nations.  The agreements include giving state Medicaid programs access to these prices.  Learn more about the agreement, the drug companies involved, and other commitments the drug companies made from this White House fact sheet.

Congress

  • The House passed the Senate’s version of a continuing resolution (CR) in a 370-48 vote, averting a September 30 government shutdown and maintaining funding levels for most government operations through December 11, 2026.
  • Majority leadership announced that the House will recess no later than September 17; lawmakers will only return if the Senate moves on a reconciliation bill.  The Senate is still scheduled to be in Washington from September 14 through October 3 before another month-long recess through election day.

Department of Health and Human Services (HHS)

  • HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have awarded $77 million in new grants to strengthen substance use prevention, treatment and recovery, community mental health, suicide prevention, and crisis services.  Learn more about the categories of grants and how the grant money will be used and find links to lists of the grant recipients in this HHS news release.
  • HHS’s Office of the National Coordinator for Health Information Technology (ONC) has released Cartos, a free HL7 FHIR terminology service for terminology assets referenced in the ONC Health IT Certification Program.  ONC health IT regulations require the use of standard terminologies to exchange health and health-related information and the purpose of Cartos is to facilitate access to those standard terminologies.  Learn more about Cartos and its use from ONC Standards Bulletin 2026-3 and the Cartos web page.

Rural Health Transformation Program Funding

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

  • To Arkansas, $149 million to expand telehealth and increase access to specialty care and preventive screenings in rural areas
  • To Hawaii, $58 million to deliver new ambulances and upgrade emergency communications systems
  • To Indiana, $120 million to expand maternal and infant health services, increase primary care access, and grow the health care workforce
  • To Virginia, $122 million to expand access to care and support workforce development and innovation

Medicaid State Plan Amendments

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

  • , establishing provider and service limits for long-term home health registered nurse and certified nursing assistant services
  • Illinois, increasing rates for physician and EPSDT services
  • Iowa, adding services outside the Four Walls Exception as a clinic benefit
  • Nevada, revising outdated terminology involving mileage expenses and independent contractors
  • Nevada, making critical access hospitals eligible for inpatient hospital upper payment limit (UPL) supplemental payments
  • Rhode Island, freezing FY 2025 reimbursement rates for hospice and home health and removing a future inflation adjustment
  • Texas, amending reimbursement methodology for Federally Qualified Health Centers (FQHC)
  • Wyoming, adding coverage and reimbursement for freestanding birthing center services
  • Oregon, revising timelines for completing and conducting criminal background checks and provider qualifications
  • Washington, adding tribal facilities as a home- and community-based setting for Community First Choice services

Health Policy Newsletters, Reports, and Videos

Centers for Disease Control and Prevention (CDC)

The CDC launched its Overdose Prevention Data Channel, a resource for fatal and nonfatal overdose data, prevention strategies, and information about CDC programs. For more details, see the CDC’s press release and the Channel’s website.

Medicare Payment Advisory Commission (MedPAC)

  • MedPAC submitted a comment letter to CMS on the agency’s proposed rule with comment period on the home health prospective payment system for CY 2027.  MedPAC expressed its support for the policy included in the proposed rule to construct a home health-specific wage index for potential use in future years.  Although the proposed payment update is larger than MedPAC’s recommendation, MedPAC also supported CMS’s efforts to better align Medicare payments with home health agency costs.  At the same time, MedPAC also expressed concern with flaws in the wage indexes Medicare uses to adjust provider payments to reflect geographic differences in labor costs.  MedPAC recommends that wage indexes be less manipulable and more accurately reflect geographic differences in market-wide labor costs and limit how much wage index values can differ among providers that are competing for the same pool of labor within a given market.  Learn more from MedPAC’s letter to CMS.
  • MedPAC submitted a comment letter to CMS in response to the agency’s proposed rule on the payment systems for hospital outpatient departments and ambulatory surgical centers for CY 2027.  In its letter, MedPAC conveyed its support for expanding Medicare site-neutral payments for imaging without contrast services that are provided in excepted off-campus provider-based departments and generally supported giving providers more autonomy in decisions about the appropriate clinical setting for performing surgical procedures.  At the same time, however, MedPAC urged CMS to proceed carefully and strengthen monitoring of patient safety and quality outcomes to ensure that the migration of procedures to ambulatory surgical centers does not adversely affect beneficiaries.  MedPAC also expressed its opposition to using the hospital market basket as an interim measure for updating ambulatory surgical center payment rates and expressed concern about the level of outpatient prospective payment system payments for 340B-acquired drugs and recommended an approach that it believes would better target support to safety-net hospitals while sharing savings from the 340B program with Medicare beneficiaries.  For more information on MedPAC’s recommendations to CMS find its letter here.

Stakeholder Events

MedPAC – Commissioners Meeting – September 4

MedPAC’s commissioners are meeting this week.  They met on Thursday, September 3 and will meet again on Friday, September 4.  Go here to find the agenda for the Friday session and go here to register to view the meeting.

HHS/Office of the Assistant Secretary for Planning and Evaluation – Physician-Focused Payment Model Technical Advisory Committee Meeting – September 14-15

HHS’s Physician-Focused Payment Model Technical Advisory Committee (PTAC) will hold a public meeting on Monday, September 14 and Tuesday, September 15 to seek stakeholder input on its draft white paper “Transforming Health Care Delivery Through Value-Based Payment Models and Care:  A Roadmap.”  The paper presents a roadmap for advancing the development and implementation of Alternative Payment Models (APMs) that supports the transformation of the health care system toward high-value, patient-centered care.  Go here to learn more about the meeting, its agenda and schedule, the people who will be making presentations, and how to participate by making a public comment.

CMS – Medicare Diabetes Prevention Program – September 15

CMS’s Medicare Diabetes Prevention Program staff will hold a webinar to discuss the removal of the program’s Once-Per-Lifetime Limit on Tuesday, September 15 at 1:00 (eastern).  This webinar will cover the background on this policy change and highlight rules and considerations for program service delivery.  Go here to learn more about the webinar and to register to participate.

CMS – PEPPER Training for Home Health Agencies and Partial Hospitalization Programs – September 24

On Thursday, September 24 at 1:00 (eastern), CMS will hold a webinar to provide training for home health agencies and partial hospitalization program facilities on how to access, interpret, and use their latest PEPPER (Program for Evaluating Payment Patterns Electronic Report) report to support data-driven decision-making.  Go here to register to participate.

MACPAC – Commissioners Meeting – September 24-25

MACPAC’s commissioners will hold their next public meeting on Thursday, September 24 and Friday, September 25.  An agenda for the meeting has not yet been posted; go here to register to participate.

CMS – PEPPER Training for Skilled Nursing Facilities – September 29

On Tuesday, September 29 at 1:00 (eastern), CMS will hold a webinar to provide training for skilled nursing facilities on how to access, interpret, and use their latest PEPPER (Program for Evaluating Payment Patterns Electronic Report) report to support data-driven decision-making.  Go here to register to participate.

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.