The following is the latest health policy news from the federal government for June 6-12.  Some of the language used below is taken directly from government documents.

Congress

Republican senators continue to work on their version of a reconciliation bill with a goal of passage by July 4, although that deadline may slip.  Some Senate committees have begun releasing their portions of the bill but the Finance Committee’s bill, with its tax and Medicaid provisions, has not yet been released.  Among the majority party in the Senate, fault lines around the House-passed reconciliation bill remain around Medicaid provider taxes, state and local tax (SALT) deductions, SNAP (formerly known as food stamps), clean energy provisions, the overall cost of the bill, and more.  Any changes made to the bill to gain enough votes for passage in the Senate will have to pass the House’s slim majority before it can become law.

The White House

The White House has issued a presidential memorandum on “Eliminating Waste, Fraud, and Abuse in Medicaid” that cites Medicaid “state directed payments” as a form of waste, fraud, and abuse.  According to the memorandum, states use state directed payments to pay more than Medicare rates for some Medicaid-covered services – something the memorandum suggests is contrary to current practice because “…billable costs for such care were historically capped at the same level that healthcare providers could receive from Medicare” – despite a 2024 regulation that set the payment limit for state directed payments at the average commercial rate and not at Medicare rates.

It is not yet clear what the implications of this presidential memorandum might be.  The memorandum does not by itself reverse already-approved state directed payment programs nor does it appear to constitute authority for or direct CMS to reject existing applications for state directed payment programs that would pay up to the average commercial rate.  The House-passed FY 2025 budget reconciliation bill would cap state directed payments but it is not yet known what form final reconciliation legislation will ultimately take.  The administration can pursue rulemaking on this issue as well – a process that already began this week with its submission of a proposed rule to the Office of Management and Budget titled “Medicaid Managed Care-State Directed Payments;” that proposed rule is classified as “pending” and no text is available.  The nature of administration rulemaking will need to conform with whatever Congress ultimately does with state directed payments in its reconciliation bill.

Find the presidential memorandum here.

Centers for Medicare & Medicaid Services
  • CMS has filed a request with the Office of Management and Budget to initiate new data collection titled “Service Level Data Collection for Initial Determinations and Appeals” to be part of Medicare Part C and D reporting requirements.  The purpose of this data collection is to provide CMS with the ability to collect more granular data related to all plan activities regarding adjudicating requests for coverage and plan procedures related to making service utilization decisions.  The proposed data elements would provide key data to CMS on the utilization of benefits, enhance audit activities to ensure that plans are operating in accordance with CMS guidelines, and ensure appropriate access to covered services and benefits.  CMS staff would use this information to monitor health plans and hold them accountable for their performance.  Learn more from this CMS notice.  The deadline for stakeholders to submit comments is June 30.
  • CMS has published a bulletin with updates of its ambulatory surgical center payment system that will take effect on July 1.  Find that bulletin here.
  • CMS has published a bulletin presenting its October 2025 update of ICD-10 and other coding revisions to national coverage determinations (NCDs).  Find that bulletin here.
  • CMS has posted a bulletin presenting its quarterly update of the end-stage renal disease (ESRD) prospective payment system.  Find that bulletin here.  The changes it describes take effect on July 1.
  • CMS has issued a national coverage determination (NCD) on non-invasive positive pressure ventilation in the home for the treatment of chronic respiratory failure consequent to COPD.  This final NCD provides for coverage of respiratory assistive devices (RADs) for the treatment of chronic respiratory failure that often accompanies COPD.   In addition, for the first time, Medicare establishes coverage criteria for home mechanical ventilation for patients with COPD.  For all other patient indications not included within the NCD, the Medicare MACs have authority to decide coverage.  Learn more from this NCD decision memo.
  • CMS has sent an informational bulletin to state Medicaid and CHIP officials announcing that it has rescinded its own 2023 bulletin titled “Guidance on Adding Sexual Orientation and Gender Identity Questions to State Medicaid and CHIP Applications for Health Coverage” and that the agency no longer intends to collect this information from state Medicaid and CHIP agencies as part of Transformed Medicaid Statistical Information System (T-MSIS) data submissions.  Find that memo here.
  • CMS has announced the expiration of four guidance memos to state governments about long-term-care facility issues:
  • CMS has added the following items to its Quality Payment Program resource library.  All of these links are direct downloads of zip files.
  • CMS has updated its Hybrid Hospital Wide Readmission and Hybrid Hospital Wide Mortality Hospital-Specific Reports.  These updated materials are now available on the measure details dashboard in the Hospital Quality Reporting System.  Go here for links and further information.
Department of Health and Human Services
  • HHS’s Office of the Inspector General (OIG) has issued a favorable opinion regarding a proposed arrangement in which a management support organization and an affiliated professional corporation would enter into an agreement with telehealth providers to lease employees and provide certain administrative services.  Find that opinion here.
  • HHS has announced the dismissal of all 17 members of the Advisory Committee for Immunizations Practices (ACIP), a formal group that makes recommendations to the CDC on the safety, efficacy, and the clinical need for vaccines.  Learn more from this HHS news release and Secretary Kennedy’s Wall Street Journal commentary in which he explains his actions.  Two days later Secretary Kennedy announced the appointment of eight individuals to fill the vacant seats; find his announcement and brief profiles of the new members from the Secretary’s announcement on X.  The ACIP’s next meeting is scheduled for June 25-27.
  • HHS’s Health Resources and Services Administration (HRSA) has announced the appointment of a new 34-member board of directors for the Organ Procurement and Transplantation Network (OPTN).  Learn more about the new board and the circumstances under which it was appointed from this HHS news release and find a list of the new board members here.  The new board members assume their role on July 1.
  • To help ensure that nursing homes are meeting their minimum staffing requirements, CMS has provided them with new data to help identify staffing gaps.  According to a new audit, some states are not sharing all of that data with nursing homes and are still not flagging some nursing home staffing shortfalls.  Learn more from the HHS OIG report “CMS Use of Staffing Data To Inform State Oversight of Nursing Homes.”  The report includes recommendations for improvement.
  • Ten of 30 selected nursing facilities did not comply or may not have complied with terms and conditions and federal requirements for expending Provider Relief Fund payments, according to an OIG audit.  Learn more from this OIG report, which includes recommendations for addressing this problem.
  • HHS’s Administration for Strategic Preparedness and Response (ASPR) has announced two locations selected to demonstrate Caspian, an automated, point-of-care, sterile saline manufacturing system that may help prevent or mitigate intravenous (IV) fluid shortages.  Learn more about why this point-of-care production approach was developed and how it would work from this HHS news release.
  • Jim O’Neill has been sworn in as deputy secretary of HHS.  Learn more about Mr. O’Neill from this HHS news release.
Approved Medicaid State Plan Amendments and State-Directed Medicaid Payments

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

  • To Michigan, updating the CPT codes applicable to primary care practitioner services.
  • To Wisconsin, approving a resource disregard of cash received in conjunction with governmental or non-governmental medical or social services programs.
  • To Montana, approving an extension of the exception to the Recovery Audit Contractor (RAC) requirements for an additional two years, through April 30, 2027.
  • To Vermont, updating limits and prior authorization requirements for physical, occupational, and speech/language therapy services to reduce the burden to access these services.
  • To Louisiana, extending the exemption from participation in the Recovery Audit Contractor (RAC) program.
  • To Virginia, updating the state’s excluded drug listing.
  • To Rhode Island, updating its state Medicaid plan to attest compliance with the new “four walls” exception for Indian Health Services and Tribal facilities.

CMS has approved the following state requests for changes or additions to state directed Medicaid managed care payments.

  • To Delaware, for a quality incentive program for inpatient hospital services, outpatient hospital services, primary care services, and specialty physician services at Nemours Children’s Hospital for the rating period covering January 1, 2025 through December 31, 2027, incorporated into the capitation rates through a risk-based rate adjustment.
  • To Kansas, authorizing a uniform increase for professional services at an academic medical center provided by qualified licensed professionals as established by the state for the rating period January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $16 million.
  • To Michigan, approving the uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
  • To Michigan, approving a uniform dollar increase for psychiatric inpatient days for the rating period covering October 1, 2024 through September 30, 2025, incorporated into the capitation rates through a separate payment term of up to $297,800,000.
  • To New Hampshire, for a uniform dollar increase for children’s inpatient and outpatient services with recognized children’s hospitals established by the state for rating periods covering September 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term amount of up to $1,229,000.
  • To New Hampshire, approving a uniform dollar increase for inpatient discharges and outpatient visits to qualifying non-critical access hospitals for the rating period covering September 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $32,413,757.
  • To New Hampshire, approving a uniform dollar increase for inpatient discharges and outpatient visits to qualifying critical access hospitals for the rating period covering September 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $56,120,600.
  • To New Mexico, approving a uniform dollar increase established by the state for eligible public and government-owned emergency medical transport providers for the rating period covering July 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $5.08 million.
  • To South Carolina, approving a uniform increase established by the state for emergency medical transport services provided by public and government-owned or operated ambulance service providers for rating periods covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term amount of up to $13,062,198.
  • To South Carolina, approving a uniform increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services providers for rating periods covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term amount of up to $16,226,538.
  • To South Carolina, approving a uniform increase established by the state for dispensing fees for independent community pharmacies for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term of up to $9,500,000.
  • To South Carolina, approving a uniform increase established by the state for emergency medical transport services provided by public and government-owned or operated ambulance service providers for rating periods covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term amount of up to $3,118,148.
  • To South Carolina, approving a uniform increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services providers for rating periods covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term amount of up to $8,183,729.
  • To Washington state, approving the uniform dollar increases established by the state for inpatient hospital services provided by eligible critical access hospitals and prospective payment system hospitals and the uniform percentage increases established by the state for outpatient hospital services provided by eligible critical access hospitals and prospective payment system hospitals for the rating period January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $2.003 billion.
  • To Washington state, approving a uniform percentage increase for inpatient and outpatient services with designated public hospitals operated by a public hospital district established by the state, excluding critical access hospitals, for the rating period January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $255.2 million.
  • To Washington state, approving a uniform percentage increase for hospitals owned and operated by or operated by a state university established by the state for inpatient and outpatient hospital services for the rating period January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $480,400,000.
  • To Washington state, approving a uniform percentage increase established by the state for behavioral health outpatient services for Medicaid-enrolled managed care enrollees delivered by Program of Assertive Community Treatment teams for the rating period covering January 1, 2025, through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
  • To Illinois, approving a uniform increase established by the state for inpatient labor and delivery services at safety-net hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $50,000,000.
  • To Illinois, approving a uniform increase for critical access hospitals established by the state for outpatient hospital services for the rating period January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $13,500,000.
  • To Illinois, approving a uniform dollar increase for nursing facilities based on quality weighted Medicaid days for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $70 million.
  • To Illinois, approving a uniform dollar increase for nursing facilities based on quality weighted Medicaid days for the rating period covering January 1, 2022 through December 31, 2022, incorporated into the capitation rates through a separate payment term of up to $29 million.
  • To Illinois, approving a uniform dollar increase for nursing facilities based on quality-weighted Medicaid days for the rating period covering January 1, 2023 through December 31, 2023, and incorporated in the capitation rates through a separate payment term of up to $58 million.
  • To Hawaii, approving a pay-for-performance arrangement established by the state for public and private nursing facilities as defined in the preprint for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $2.8 million.  Also approves a uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $17.86 million.
  • To Texas, approving a quality improvement payment program for the rating period covering September 1, 2024 through August 31, 2027, incorporated into the capitation rates through a risk-based rate adjustment.
  • To Pennsylvania, approving a uniform increase for professional services furnished by physician practice plans affiliated with a medical school located in Philadelphia and accredited by the Liaison Committee on Medical Education for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through separate payment term of up to $35,572,805.
  • To Pennsylvania, approving a uniform increase for professional services furnished by eligible physician practices for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $38 million.
  • To Pennsylvania, approving a value-based payment arrangement for opioid use disorder for private acute-care hospitals for the rating period covering January 1, 2025 through December 31, 2027, incorporated into the capitation rates through a separate payment term of up to $35 million per annual rating period.
  • To Pennsylvania, approving a value-based payment arrangement focused on potentially preventable admissions for private acute-care hospitals for the rating periods covering January 1, 2025 through December 31, 2027, incorporated into the capitation rates through a separate payment term of up to $45 million per annual rating period.
  • To Pennsylvania, approving the value-based payment arrangement providing incentive payments to acute-care general hospitals established by the state for the rating periods covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $30 million per annual rating period.
  • To Pennsylvania, approving a value-based payment arrangement for opioid use disorder for private acute-care hospitals for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $35 million.
  • To Nevada, approving a uniform percentage increase for eligible professional services at designated academic medical centers for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $59,883,102.81.
  • To Nevada, approving a uniform percentage increase for inpatient and outpatient hospital services at non-state governmentally owned hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $197,169,083.
  • To Nevada, approving a value-based payment established by the state for freestanding nursing facilities for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $27,415,240.67.
  • To Tennessee, approving a value-based payment and uniform percentage increase established by the state for professional services at an academic medical center for the rating period January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $15,741,366.
  • To Tennessee, approving a uniform percentage increase established by the state for nursing facility services for the rating period January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $41,482,710.
  • To Wisconsin, approving a uniform percentage increase established by the state for eligible home- and community-based services for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $151,500,000.
  • To Massachusetts, approving a minimum fee schedule for psychiatric services for enrollees under the age of 21 with autism spectrum disorder or intellectual or developmental disability for the rating period covering January 1, 2023 through September 30, 2023, provided by the state’s Prepaid Inpatient Health Plan, incorporated into the capitation rates through a risk-based rate adjustment.
  • To Delaware, approving a uniform percentage increase established by the state for personal care service claims for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
  • To Virginia, approving the minimum fee schedule established by the state for durable medical equipment providers for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a risk-based rate adjustment.
  • To Mississippi, approving a uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $6,603,083.
HHS Newsletters, Reports, and Videos
Medicare Payment Advisory Commission (MedPAC)

Learn more from this MedPAC news release and the full report to Congress.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC has released its June 2025 “Report to Congress on Medicaid and CHIP,” with recommendations on improving transitions from pediatric to adult care for Medicaid-covered children and youth with special health care needs.  The report also addresses appropriate access to residential behavioral health treatment services for children with Medicaid coverage, access to medications for opioid use disorder in Medicaid, the Program of All-Inclusive Care for the Elderly (PACE), and self-direction for Medicaid home- and community-based services.  Learn more from this MACPAC news release and the full MACPAC report to Congress.

Centers for Disease Control and Prevention (CDC)

The CDC has warned of a Salmonella outbreak linked to eggs sold to restaurants and retailers in Arizona, California, Illinois, Indiana, Nebraska, New Mexico, Nevada, Washington, and Wyoming.  The eggs were all sold by the August Egg Company under several product names.  Learn more about the Salmonella outbreak, the eggs, and the recall of the suspect eggs from this CDC media alert and an accompanying food safety alert.

National Institutes of Health (NIH)

The NIH has issued a request for information seeking perspectives on the development of an NIH artificial intelligence strategy.  The agency is developing an agency-wide AI strategy that seeks to chart a progression from today’s data science-driven analytics through semi-autonomous AI agents to fully autonomous, self-documenting biomedical AI beings.  To inform this effort, the NIH invites public comment on themes, pillars, and specific actions that should shape the forthcoming NIH AI Strategic Plan and its early one-year action plan.  Learn more about the NIH’s intentions and the specific areas where it seeks public input from this request for information announcement, which includes information about how to submit comments by the July 15 deadline.

Stakeholder Events

CMS – Clinical Laboratory Fee Schedule Annual Public Meeting — June 27

CMS will hold a public meeting to receive comments and recommendations on the appropriate basis for establishing payment amounts for new or substantially revised Healthcare Common Procedure Coding System (HCPCS) codes being considered for Medicare payment under the clinical laboratory fee schedule for calendar year 2026.  This meeting provides a forum for those who submitted certain reconsideration requests regarding final determinations made last year on new test codes and for the public to provide comments on the requests.  The meeting will be held on Friday, June 27 from 10:00 to 4:00 and will be available both virtually and in person on the CMS campus in Baltimore.  Learn more about the meeting and its purpose and how to submit written comments from this CMS announcement.  Registration is only required for individuals giving a presentation during the meeting or attending the meeting at the CMS campus; go here to register.

CMS – CMS Quality Conference – July 1-2

CMS will hold a quality conference on Tuesday, July 1 and Wednesday, July 2 in Baltimore.  Go here for the conference agenda, an FAQ, and to register to participate.