The following is the latest health policy news from the federal government for December 19–December 29.  Some of the language used below is taken directly from government documents. 

Rural Health Transformation Fund 

The Centers for Medicare & Medicaid Services (CMS) today announced that all 50 states will receive awards under the Rural Health Transformation Program, a $50 billion initiative established under the 2025 reconciliation bill, H.R. 1, to strengthen and modernize health care in rural communities across the country. In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million.

The Rural Health Transformation Program’s $50 billion in funds will be allocated to approved states over five years, with $10 billion available each year from 2026 through 2030.  As directed by H.R. 1, 50 percent of the funding is distributed equally among all approved states and 50 percent is allocated based on a variety of factors. including individual state metrics around rurality and a state’s rural health system, current or proposed state policy actions that enhance access and quality of care in rural communities, and application initiatives or activities that reflect the greatest potential for, and scale of, impact on the health of rural communities.  The amounts awarded to states are listed here in alphabetical order:

    State     Amount
 Alabama $203,404,327
 Alaska $272,174,856
 Arizona $166,988,956
 Arkansas $208,779,396
 California $233,639,308
 Colorado $200,105,604
 Connecticut $154,249,106
 Delaware $157,394,964
 Florida $209,938,195
 Georgia $218,862,170
 Hawaii $188,892,440
 Idaho $185,974,368
 Illinois $193,418,216
 Indiana $206,927,897
 Iowa $209,040,064
 Kansas $221,898,008
 Kentucky $212,905,591
 Louisiana $208,374,448
 Maine $190,008,051
 Maryland $168,180,838
 Massachusetts $162,005,238
 Michigan $173,128,201
 Minnesota $193,090,618
 Mississippi $205,907,220
 Missouri $216,276,818
 Montana $233,509,359
 Nebraska $218,529,075
 Nevada $179,931,608
 New Hampshire $204,016,550
 New Jersey $147,250,806
 New Mexico $211,484,741
 New York $212,058,208
 North Carolina $213,008,356
 North Dakota $198,936,970
 Ohio $202,030,262
 Oklahoma $223,476,949
 Oregon $197,271,578
 Pennsylvania $193,294,054
 Rhode Island $156,169,931
 South Carolina $200,030,252
 South Dakota $189,477,607
 Tennessee $206,888,882
 Texas $281,319,361
 Utah $195,743,566
 Vermont $195,053,740
 Virginia $189,544,888
 Washington $181,257,515
 West Virginia $199,476,099
 Wisconsin $203,670,005
 Wyoming $205,004,743

 

You can read more about the Rural Health Transformation Program awards, including how much each state was awarded, here, as well as the RHT Program State Project Abstracts, here. 

Congress 

The House and Senate are not in session – both chambers will convene January 6, 2026.  Funding for the federal government expires January 30, 2026. 

New CMS Models 

Global Benchmark for Efficient Drug Pricing (GLOBE) Model – Mandatory 

CMS has proposed a GLOBE – Global Benchmark for Efficient Drug Pricing – Model that seeks to test a new rebate formula for manufacturer rebates for certain separately payable Medicare Part B drugs, which are medications typically administered by physicians in health care settings.  The intent of the proposed mandatory GLOBE Model is to test a payment model that modifies the current Medicare Part B drug inflation rebate calculation for GLOBE Model drugs using international drug pricing information to identify a benchmark that reflects prices paid in economically comparable countries.  Categories of drugs to be included in the program include immunological agents, ophthalmic agents, blood products and modifiers, chemotherapy drugs, central nervous system agents, anti-gout agents, and metabolic bone disease agents.  CMS believes this approach will reduce federal expenditures for Medicare Part B while preserving or enhancing beneficiaries’ quality of care.  GLOBE inclusion criteria would exclude biosimilars and their reference biologicals once a biosimilar enters the market in the U.S.  Participants in the model would be manufacturers of drugs covered by Medicare Part B that are not otherwise excluded from the GLOBE Model.  Providers would not be participants and would not see a reduction in their overall Part B payments.

The GLOBE Model would operate for five years, beginning October 1 2026 and ending September 30, 2031, with rebate invoicing and reconciliation continuing until September 30, 2033.  The model would apply to Medicare beneficiaries who reside in defined geographic areas encompassing approximately 25 percent of Medicare beneficiaries in the U.S.; CMS will select those areas at a later date.  Learn more from this CMS news release, the GLOBE web page, and the proposed regulation that would create GLOBE.  The deadline for submitting comments about the proposed regulation is February 23.

Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model – Mandatory 

CMS has proposed a GUARD – Guarding U.S. Medicare Against Rising Drug Costs – Model that would test a new rebate formula for Medicare Part D drugs that includes outpatient prescription drugs typically dispensed at retail, mail order, home infusion, and long-term care pharmacies.  The mandatory GUARD Model, which moves beyond the Inflation Rebate Program, would factor in existing Medicare Part D manufacturer rebates and discounts and test a change in the calculation of inflation rebates in Medicare Part D that accounts for how much certain drugs cost in economically similar countries.  CMS believes this approach will reduce program expenditures for Medicare Part D while preserving or enhancing beneficiaries’ quality of care.  GUARD would not reduce Part D participants’ out-of-pocket costs for their prescriptions.  The scope of drugs involved in this program is broader than that for the GLOBE Model.  Participants in the model would be manufacturers of drugs covered by Medicare Part D and not providers.

The GUARD Model would begin on January 1, 2027 and operate for five years with rebate invoicing and payment continuing until 2033.  The model would encompass 25 percent of Part D enrollees and would only apply to beneficiaries that live in randomly selected geographic areas.

Learn more about the GUARD Model from this CMS news release; the proposed regulation; and the GUARD Model web page.  The deadline for interested parties to submit written comments is February 23.

Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model – Voluntary

CMS also announced a new voluntary model:  a test of a model that is designed to enable Medicare Part D plans and state Medicaid agencies to cover GLP-1 medications used for weight management and metabolic health improvement while helping control costs for patients and taxpayers.  Under the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model, CMS will negotiate directly with pharmaceutical manufacturers of GLP-1 drugs for lower net prices and standardized coverage terms.  Negotiation areas include guaranteed net pricing and potential out-of-pocket limits for beneficiaries; standardized coverage criteria; and evidence-based lifestyle support offerings.  Participation will be voluntary for manufacturers, states, and plans.  CMS will release additional information early next year about state and Part D plan participation.  The BALANCE Model will launch in Medicaid as early as next May and in Medicare Part D in January of 2027.  CMS has issued a request for applications to manufacturers; those applications are due January 8, 2026.  CMS also has issued notices of intent for state Medicaid agencies and Medicare Part D plans, which also are due January 8, 2026.  Learn more about the BALANCE Model from this CMS news release and the BALANCE Model web page.

Medicare GLP-1 Payment Demonstration – Voluntary 

Prior to the launch of the BALANCE Model, CMS also plans to implement a new Medicare GLP-1 payment demonstration beginning in July of 2026 that will serve as a short-term bridge to the model.  This additional payment demonstration means that Medicare beneficiaries can start gaining access to these medications at prices negotiated by the administration as soon as possible.  This demonstration will operate outside of the Medicare Part D benefit’s coverage and payment flow, which means that Part D Plan sponsors will not carry risk for eligible GLP-1 products furnished under the demonstration.  Beneficiaries enrolled in Medicare Part D who meet the negotiated access criteria will have access to these drugs.  Under the demonstration, eligible Medicare beneficiaries will pay $50 for a month of GLP-1 medications.  CMS will provide additional information on the design and implementation of the GLP-1 payment demonstration in early 2026. 

New Proposed Payer Price Transparency Requirements

CMS, working with the Department of Labor and the Department of the Treasury, has proposed changes in current health care payer price transparency rules (for most health insurers and health plans).  Noting that the data the current rules generate has been difficult to obtain and navigate and includes oversized files, duplicative data, and information that cannot easily be compared across insurers, CMS proposes changes that would simplify how the data is compiled, organized, and shared with consumers by:

  • Reducing the number and size of machine-readable files, increasing accessibility to make data more meaningful, making data more usable, and making data easier to locate.
  • Better aligning payer and hospital data reporting.
  • Requiring plans and issuers to exclude from in-network rate files certain data for services providers would be unlikely to perform.
  • Reorganizing in-network rate files by provider network rather than by plan, cutting redundancy and aligning with how most hospitals report data under current transparency requirements.
  • Requiring change-log and utilization files so users can easily identify what has changed.
  • Reducing reporting frequency.
  • Increasing the amount of out-of-network pricing information reported.
  • Aligning payer price comparison tools with consumer protections established under the No Surprises Act.

Learn more from the proposed rule and this CMS fact sheet.  The deadline for interested parties to submit comments is February 21. 

H-1B Work Visas 

The Department of Homeland Security is amending regulations governing the H-1B work visa selection process to prioritize the allocation of visas to higher-skilled and higher-paid applicants.  A new rule replaces the current, random lottery for selecting visa recipients with a process that gives greater weight to those with higher skills.  Learn more from this Department of Homeland Security news release and the final rule itself, which takes effect on February 27.

Centers for Medicare & Medicaid Services 

  • On December 1, CMS and its Center for Medicare and Medicaid Innovation introduced their new ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, which seeks to give original Medicare providers and patients access to high-value, technology-supported care options to better prevent and manage chronic disease.  Last week, CMS posted a form for interested providers to express their interest in participating in the model; find that form here.  Now, CMS has posted a formal request for applications from providers interested in participating in the model; find that request for applications here.  Learn more about the program on the ACCESS Model web page.
  • The CMS administrator has posted a commentary presenting the objectives of the ACCESS program and outlining how that program will seek to link technology-supported care with outcome-aligned payments.  Find that commentary here.
  • CMS has established an Office of Rural Health Transformation. The office’s primary role will be to establish and oversee the federal Rural Health Transformation Program.  The office’s Division of State Rural Engagement will provide rural health transformation policy and operational guidance to states and internal and external stakeholders to ensure appropriate policy application.  Learn more about the new office and its anticipated responsibilities and areas of endeavor from this formal CMS notice.  Learn more about the Rural Health Transformation Program from the program’s web page.
  • CMS reminds hospitals that under the current continuing resolution funding the federal government, which runs until January 30, it will no longer accept waiver requests to participate in the Medicare Acute Hospital Care at Home program after January 1. In addition, all hospitals with active waivers must discharge program participants by January 30 or return those patients to the hospital.  Learn more from this CMS notice.
  • CMS has posted a bulletin describing payment for Medicare Part B preventive vaccines and their administration for rural health clinics and Federally Qualified Health Centers.  The bulletin clarifies reimbursement practices the agency published in January of 2025 and that took effect in July of 2025.  Find the bulletin here. 
  • CMS has posted a bulletin presenting its CY 2026 update of the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule.  Find the bulletin here.  It takes effect on January 1. 
  • CMS has posted a bulletin describing a new edit for coding for outpatient services for hospice patients.  Find the bulletin here.  The change takes effect on April 1, 2026.
  • CMS has added CY 2023 Quality Payment Program performance information for clinicians, groups, and accountable care organizations (ACOs) to the provider data catalog and on their profile pages on the Medicare.gov compare tool.  CMS is required to report the final scores and performances of Merit-based Incentive Payment System (MIPS)-eligible clinicians under each MIPS performance category, names of eligible clinicians in advanced alternative payment models, and the names of such advanced alternative payment models.  Performance information for clinicians is displayed using measure-level star ratings, percent performance scores, and check marks.  Learn more from this CMS announcement on the “Care Compare: Doctors and Clinicians Initiative” web page, which includes additional information about the data, fact sheets, and links to the data.
  • CMS has sent an informational bulletin to the states to highlight statutory changes that affect Medicaid and CHIP eligibility requirements for individuals who are inmates of public institutions. According to the memo, beginning on January 1 states must ensure that they do not terminate Medicaid eligibility for an individual or CHIP eligibility for any targeted low-income child or pregnant woman when only due to their status as an inmate of a public institution.  The bulletin also reminds states of operational strategies, including suspension of eligibility or benefits, available to effectuate this requirement while ensuring appropriate claiming of federal financial participation (FFP) for services provided to individuals who are incarcerated.  Learn more from this CMS bulletin to state Medicaid and CHIP programs.
  • CMS has sent an informational bulletin to the states announcing that until January 1, 2029 it does not anticipate taking enforcement action against states regarding the deadline for their interested parties advisory group to initially convene and provide recommendations to the Medicaid agency, as required by law. Under that law, states are required to convene the interested parties advisory group at least every two years and must publish the group’s recommendations within one month of when that advisory group meets and provides recommendations to the state Medicaid agency.  CMS will use this time to consider proposing changes to these requirements in future notice-and-comment rulemaking.  Learn more from this CMS memo to state Medicaid programs.
  • CMS has released the updated 2026 CMS Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG) for the eligible clinician program, reflecting changes finalized in the 2026 Medicare physician fee schedule final rule published on October 31, 2025. The updated QRDA III IG provides detailed requirements for eligible clinicians to report electronic clinical quality measures (eCQMs) for CY 2026 quality reporting programs.  Learn more about the update, including its individual components, from this CMS announcement.
  • CMS’s A/B Medicare Administrative Contractors (MACs) have announced the withdrawal of the Local Coverage Determinations (LCDs) for Skin Substitute Grafts/Cellular and Tissue-Based Products for the treatment of Diabetic Foot Ulcers (DFUs) and Venous Leg Ulcers (VLUs), effective December 24, 2025.  These LCDs were originally scheduled to take effect on January 1, 2026, but CMS has decided not to move forward with implementation at this time.  For more information see the fact sheet here. 

Department of Health and Human Services 

  • HHS has declared a public health emergency for the state of Washington to address the health effects caused by recent severe storms, straight-line winds, flooding, landslides, and mudslides. The declaration authorizes CMS to give Medicare- and Medicaid-enrolled health care providers and suppliers greater flexibility to meet emergency health needs.  Learn more about the federal resources that have been authorized to assist in Washington from this press release and about the specific waivers CMS has extended from the CMS “current emergencies” web page.
  • State Medicaid agencies made millions in unallowable capitation payments to managed care organizations on behalf of deceased enrollees, HHS’s Office of the Inspector General (OIG) concluded after a recent audit. In all, 18 OIG audits identified $289 million in such payments.  Learn more about what the OIG found and the steps it recommended for CMS to take to prevent such payments in the future from this OIG report.

HHS/ Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology

  • HHS’s Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) has published a proposed rule that focuses on deregulatory actions addressing regulatory health information technology standards, implementation specifications, and certification criteria and certification programs for health information technology and information blocking. According to ASTP/ONC, the proposed rule seeks to reduce burden, offer flexibility to developers and providers, and support innovation through the removal and revision of certain certification criteria and regulatory provisions.  The proposed rule also seeks to address reported misuse and abuse of information blocking definitions and exceptions and to advance a new foundation of AI-enabled interoperability solutions through modernized standards and certification.  Learn more about the proposed rule from this news release and this fact sheet and from the proposed rule itself.  The deadline for stakeholders to submit comments is February 27.
  • At the same time, HHS and ASTP/ONC have issued a request for information (RFI) seeking public input on how the federal government can accelerate the adoption and use of artificial intelligence as part of clinical care. Specifically, they seek feedback on how HHS can use its regulatory, reimbursement, and research and development tools to enable AI adoption to enhance the American health care system, including by using AI to improve patient and caregiver experiences and outcomes, reduce provider burden, improve quality of care, and reduce health care costs for consumers and government.  This includes how digital health and software regulatory frameworks should evolve to account for AI-driven tools while maintaining patient safety; how reimbursement structures can be simplified and better aligned to support the use of efficient, deflationary technologies; and how research and development investments can strengthen implementation science and best practices, especially for complex or high-acuity clinical scenarios.  Learn more from the RFI, which invites general comments and also poses specific questions for interested parties, and find additional information about the kind of feedback the agency seeks from this ASTP/ONC blog post.  The deadline for submitting comments is February 23.
  • ASTP/ONC has posted four new FAQs addressing revenue sharing (here), the Manner Exception (here and here), and information blocking (here). 

Medicaid State Plan Amendments

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

  • To Vermont, adding targeted case management for adults with serious mental illness.
  • To Connecticut, to cover medical nutrition therapy services under the preventive services benefit when rendered by certified dietitian-nutritionists enrolled in Connecticut’s Medicaid program.
  • To Maryland, lowering the threshold for environmental lead investigations from a confirmed elevated blood lead level of 5 μg/dL to 3.5 μg/dL.
  • To Georgia, removing the scheduled end date for the required medication-assisted treatment program.
  • To Ohio, establishing coverage and a per diem payment rate for services provided by pediatric recovery centers, which are residential infant care centers, a new provider type created to treat infants with significant substance exposure resulting in physical withdrawal symptoms.
  • To Florida, updating DRG reimbursement rates for hospital inpatient services, specifying calculation of 2024-25 base rates using claims data from the calendar year ending 18 months prior to the rate effective date; updating the amount of DRG per-discharge add-on payment and year for children’s hospital per-discharge add-on payments; adding a service adjustor for services categorized as obstetrics or normal newborn to the three types of policy adjustors built into the DRG-based payment method; and adding an end date to the methodology for certain existing graduate medical education (GME) payments.
  • To Wisconsin, updating state plan language related to vaccine coverage under the preventive services benefit as recommended by the United States Preventive Services Task Force grade A and B preventive services and vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).
  • To Illinois, reimbursing hospitals for high-cost drugs and providing for the exclusion for drugs that cost more than one million dollars from the expensive drugs and devices add-on payment.
  • To Alabama, adding psychologists and physician assistants as provider types to support children and youth with special health care needs in interdisciplinary clinics.
  • To Massachusetts, confirming that Indian Health Services and tribal health facilities can provide services outside of the four walls of their facilities.
  • To Arizona, authorizing Arizona disproportionate share hospital (DSH) pool 1, 2, 1A, 2A, and 4 payments for the DSH state plan rate year ending 2026.
  • To Texas, updating school health and related services pages within the reimbursement methodologies for the Early and Periodic Screening, Diagnosis, and Treatment Comprehensive-Care Program (EPSDT-CCP) section of the state plan.
  • To Nebraska, changing the nursing facility inflation factor for state fiscal year 2026.
  • To Nebraska, changing the inflation factor for intermediate-care facilities for individuals with developmental disabilities for state fiscal year 2026.
  • To Alabama, adding three additional hospitals and enhanced payments to physicians.
  • To Montana, adopting version 42 of the APR-DRG grouper and increasing inpatient hospital reimbursement base rates.
  • To Washington, updating nursing facility rate effective dates.
  • To Georgia, updating the neonatologists and maternal fetal medicine specialists reimbursement rate.
  • To Texas, acknowledging that as of September 1, 2025, the Texas Health and Human Services Commission will no longer have a Superior Waiver in place under 42 CFR Part 456, subpart H that waives the requirements of subpart C for all hospitals and all mental hospitals for a state that sufficiently demonstrates utilization review procedures superior to the federal requirements. This amendment includes pages for subpart C and subpart D.
  • To New Mexico, providing screening, diagnostic, and targeted case management (TCM) services to eligible justice involved youth

HHS Newsletters, Reports, and Videos 

  • Health Resources and Services Administration – HRSA eNews – December 18
  • Agency for Healthcare Research and Quality – AHRQ News Now – December 23
  • CDC – Mortality and Morbidity Weekly Report – “Coal Workers’ Pneumoconiosis–Associated Deaths – United States, 2020–2023” – December 18
  • HRSA – Organ Procurement and Transplantation Network – OPTN Monthly Update – December
  • OPTN – public comment opportunity notice – deadline for submitting comments is January 18
  • OPTN Bulletin – December 23 

Centers for Disease Control and Prevention (CDC) 

  • 2012 confirmed measles cases have been reported in 44 jurisdictions in the U.S. as of December 23; 11 percent of these cases have required hospitalization and three deaths have been confirmed. Learn more about this year’s measles outbreak, where it has occurred, and how this year’s outbreak compares with recent years from this CDC report.
  • Sixty-four people across 22 states have gotten sick, and 20 of them have been hospitalized, with the same strain of salmonella. While the CDC continues to investigate, the outbreak appears to be attributable to the consumption of oysters.  Learn more about the outbreak, the strain of salmonella, and what clinicians should know about the outbreak from this CDC notice. 
  • Earlier this month the CDC held a webinar for clinicians during which it presented its 2025-2026 clinical recommendations for seasonal influenza prevention, control, and treatment. Go here to find a recording of that webinar along with a transcript of the event and the slides the CDC presented. 

Government Accountability Office (GAO) 

  • People with disabilities may encounter barriers related to accessibility in the U.S. health care system; these barriers can affect the quality of their care. The GAO has analyzed research literature on health care accessibility, conducted interviews with stakeholders, identified potential barriers to care, and offered recommendations for addressing those barriers in its report “Health Care Accessibility:  Further Efforts Needed to Address Barriers for People with Disabilities.”  The GAO also published a separate version of this report to make it more accessible to certain people with disabilities.  Find this alternative version here.

Stakeholder Events 

CMS – PEPPER Webinar – January 6

CMS will hold a webinar to provide guidance on recent changes the agency made to its Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute-care hospitals and to review the reports it published this month.  The webinar will be held on Tuesday, January 6 at 1:00 (eastern).  Go here for additional information about the webinar and to register to participate. 

MedPAC – Commissioners Meeting – January 15-16

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, January 15 and Friday, January 16.  An agenda and participation information are not yet available but when they are they will be posted here.

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 and participation information are not yet available but when they are they will be posted here. 

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.  ASTP will soon post information on the meeting’s agenda, how to register, and how to reserve a hotel room through ASTP’s room block.  When it does, that information will be posted here.

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. 

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.