The following is the latest health policy news from the federal government for March 20-26.  Some of the language used below is taken directly from government documents.

Congress
  • Republican leadership is exploring a reconciliation bill as a potential vehicle to fund Immigrations and Customs Enforcement (ICE) and pass the Safeguard American Voter Eligibility Act (SAVE) voting rights act.  If pursued, this approach could increase the likelihood of additional health care cuts, including expanding site-neutral payment policies in both Medicare and Medicaid.  It is not clear whether there will be sufficient support in either chamber for Republicans to pursue a party-line bill this year.  If the majority moves forward with this strategy, legislative activity could occur before the mid-term elections.
  • The House Energy and Commerce Committee’s Subcommittee on Health today held a hearing titled “Policies to Protect Our Communities From Illicit Drug Threats” to discuss various bills that address emerging substance use-related challenges.  Learn more from this news release and this recording of the hearing.
  • The House Ways and Means Committee is expected to hold a hearing on health care affordability, with a focus on hospital costs and consolidation, in mid‑April.  Updates will be posted on the committee’s official calendar here.
  • Both chambers of Congress will be out of session during the first two weeks of April.
Centers for Medicare & Medicaid Services
  • CMS has announced that it has adopted a regulation that implements new standards for health care claims attachment transactions and electronic signatures.  The rule establishes HIPAA-compliant standards for health care claims attachments, enabling the secure electronic exchange of health care claims-related supporting clinical documentation and attachments such as medical records, x-rays and imaging, clinical notes, telemedicine visit documentation, and laboratory results.  In so doing, it eliminates the use of direct mail and fax to transmit such information.  The rule also establishes requirements for electronic signatures to ensure that health care claims attachment transactions are secure, authenticated, and compliant with federal standards.  While in its proposed form the draft rule included standards for both health care claims and prior authorization attachments, the final rule focuses exclusively on health care claims attachments; it does not establish prior authorization attachments standards.  Learn more about the final rule, including what it does and does not cover, from this CMS news release, an accompanying CMS fact sheet, and the final rule itself.  The standards and mechanisms presented in the rule take effect on May 26 and covered entities must come into compliance with the rule’s requirements by May 26, 2028.
  • CMS has announced the launch of the ASPIRE (Accelerating State Pediatric Innovation Readiness and Effectiveness) Model.  The model will support whole-person care delivery for children up to 21 who are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) who either have or are at risk of developing complex medical and/or behavioral needs.  ASPIRE will seek to position Medicaid providers to assume accountability for the quality and cost of care for these populations, providing children, youth, and their families with care coordination and other supports across the continuum of physical and behavioral health while incorporating quality measures focused on outcomes.  ASPIRE will be a ten-year, $125 million voluntary model with CMS contracting directly with up to five state Medicaid agencies.  Those agencies, in turn, will partner with organizations responsible for managing total health care costs and improving care for the covered children and youth.  CMS will release a Notice of Funding Opportunity later this year.  Learn more from the new ASPIRE web page and this commentary by CMS administrator Dr. Mehmet Oz and director of the Center for Medicare and Medicaid Innovation and CMS deputy administrator Abe Sutton.
    • In coordination with the announcement of this program, HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) has posted the new report “Accelerating Innovative and Effective Pediatric Health Care Delivery Systems:  Interventions and Value-Based Care Models for Children with Chronic Health Conditions and Complex Needs.”  Find that report here.
  • Last week CMS brought together leaders from all 50 states for a Rural Health Transformation Summit.  Participants included state Rural Health Transformation Program directors, CMS leadership, CMS Office of Rural Health Transformation project officers, and subject matter experts as part of an effort to align implementation priorities, exchange perspectives, and support progress across rural communities nationwide.  The summit focused on early implementation that addressed the program’s five strategic goals:  Make Rural America Healthy Again, sustainable access, workforce development, innovative care, and tech innovation.  Learn more about the proceeds from this CMS summary of the March 18 event.
  • CMS has extended the deadline for responding to its Outpatient Prospective Payment System Drug Acquisition Cost Survey to April 7.
  • CMS has added the following item 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
  • Last summer, HHS and CMS announced the creation of a new “Healthcare Advisory Committee,” which they described as “…a group of experts charged with delivering strategic recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz to improve how care is financed and delivered across Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.”  Now, the agencies have revealed the names of 18 individuals who will serve on the committee.  Learn more about the committee, its purpose, and its 18 members from this CMS news release; from the original announcement about the committee’s creation; and from the Healthcare Advisory Committee web page.
  • HHS’s Administration for Strategic Preparedness and Response (ASPR) has updated its Hospital Preparedness Program guidance.  The new guidance includes updates and clarifications to support recipients in conducting Hospital Preparedness Program activities during the upcoming budget period as part of the program’s objective of increasing state and local readiness to care for patients during disasters and emergencies.  ASPR contracts for this program with the states, which in turn support health care coalitions, networks of public and private health care and emergency response organizations, and others.  Learn more about the Hospital Preparedness Program and the updated guidance from this HHS news release.
  • ASPR has awarded $8.3 million to the API Innovation Center to expand domestic manufacturing capacity for the active pharmaceutical ingredients propofol and metoprolol, both of which are on the FDA’s List of Essential Medicines, Medical Countermeasures, and Critical Inputs.  Learn more from this ASPR news release.
Medicaid State Plan Amendments

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

  • To Connecticut, to reimburse hospitals for sickle cell disease drugs separately from the inpatient All Patient Refined Diagnosis Related Group (APR-DRG) payment when the drugs are approved under the Cell and Gene Therapy Access Model.
  • To Hawaii, removing the income and resource standards for the Ticket to Work and Work Incentives Improvement Act basic eligibility group.
  • To Idaho, adding and modifying benefits in the Idaho Medicaid state plan basic and enhanced alternative benefit plans.
  • To Idaho, another amendment adding and modifying benefits in the Idaho Medicaid state plan basic and enhanced alternative benefit plans.
  • To Iowa, removing the end date for coverage of medication-assisted treatment services in accordance with Section 201 of the Consolidated Appropriations Act of 2024.
  • To Kentucky, updating the single case agreement for high-cost cell and gene therapies.
  • To Kentucky, establishing an exception to the Recovery Audit Contractor (RAC) program.
  • To Maine, adding coverage for clinic services outside of the “four walls” of IHS/tribal clinics.
  • To Massachusetts, imposing as a condition of Medicaid eligibility that applicants and beneficiaries who may be eligible for Medicare must apply for Medicare as a condition of their Medicaid eligibility.
  • To Minnesota, moving residential substance use disorder services provided by Indian Health Services or Tribal 638 facilities to the rehabilitative services benefit on the reimbursement pages within the state plan.
  • To Montana, adding the Healing and Ending Addiction through Recovery and Treatment Re-Entry Targeted Case Management program, which will serve Medicaid-enrolled individuals who are incarcerated at the Montana state prison, Montana women’s prison, and/or Riverside.
  • To Nevada, expanding the managed care program statewide.
  • To New Mexico, providing medication-assisted treatment in accordance with Section 201 of the Consolidated Appropriations Act of 2024 and making permanent the mandatory Medicaid benefit for medications for opioid ese disorder.
  • To Oklahoma, increasing the Medicaid per-mile reimbursement rate for secure behavioral health transportation services exceeding 30 miles from $2.85 to $4.80.
  • To Pennsylvania, to continue funding multiple classes of disproportionate share hospital (DSH) payments to Medical Assistance-enrolled, qualifying acute-care general hospitals.
  • To Pennsylvania, establishing a new class of supplemental payments to qualifying Medical Assistance-enrolled acute-care general hospitals.
  • To Rhode Island, memorializing new income standards for the state’s supplementary payment program and medically needy groups and adjusting the parent/caretaker income limit to 133 percent of the federal poverty level.
  • To South Carolina, increasing the personal needs allowance amount for individuals residing in nursing and intermediate-care facilities for individuals with intellectual disabilities.
  • To South Carolina, updating reimbursement rates for rehabilitative behavioral health services.
  • To Virginia, updating language regarding patient pay deductions.
  • To Virginia, removing obsolete language that pertains to increased primary care service payments.
  • To Washington, assisting beneficiaries who were evacuated or temporarily absent from the state because of the public health emergency to remain as state residents.
  • To Washington, updating the state plan to accommodate an additional facility.
  • To West Virginia, addressing reimbursement for certain drugs outside of the inpatient hospital Diagnosis Related Group (DRG) payment methodology.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – March 26
  • CMS – video of the 2026 CMS Industry Forum, which primarily addressed agency procurement
  • HHS/Health Resources and Services Administration (HRSA) – HRSA eNews – March 26
  • CDC – Morbidity and Mortality Weekly Report (MMWR) – “Early Detection and Surveillance of the SARS-CoV-2 Variant BA.3.2 – Worldwide, November 2024–February 2026” – March 19
  • HHS/Health Resources and Services Administration (HRSA) – OPTN Modernization Update – March
  • Agency for Healthcare Research and Quality – AHRQ News Now – March 24
Federal Trade Commission (FTC)

The Federal Trade Commission announced that it will form a health care task force that will engage in a coordinated, integrated approach to health care enforcement and advocacy to protect patients, health care workers, and taxpayers.  The task force will lead targeted enforcement and advocacy initiatives focused on key priorities; devise coordinated agencywide strategies on investigations; take an active and strategic approach to identifying amicus and statement of interest opportunities; and identify emerging issues and new priority areas for enforcement and advocacy.  Learn more about the task force from this FTC news release and this memo from the FTC chair to FTC staff directing the task force’s creation and outlining its scope of endeavor.

Congressional Research Service

The Congressional Research Service has published a report that identifies selected resources for national, state, and local-level (i.e., congressional district or county level) data on Medicaid enrollment and enrollee characteristics that are frequently evaluated when examining Medicaid policy options.  Find that report here.

Stakeholder Events

HHS/Administration for Strategic Preparedness and Response – Strengthening Health Care Cyber Resilience:  RISC 2.0 Webinar – March 30

HHS’s Administration for Strategic Preparedness and Response (ASPR) will hold a webinar on March 30 at 2:00 (eastern) to explain how its new RISC (Risk Identification and Site Criticality) 2.0 cybersecurity module can help health care organizations assess vulnerabilities and fill gaps in their cyber defenses.  Learn more about the webinar and find registration information in this ASPR notice.

CMS – Medicare Drug Price Negotiation Program Public Engagement Events – April 6-23

From April 6 through April 23, CMS will hold a series of public information events to gather stakeholder information about its Medicare Drug Price Negotiation Program and the specific prescription drugs covered by that program.  The agency invites patients, caregivers, clinicians, and others to share their experience relevant to the drugs selected for negotiation and renegotiation under the program.  Learn more from this CMS bulletin about the public informational events and learn more about the individual events, the specific drug or drugs each event will address, and how to participate from this CMS web page.

CMS – Fourth Quarter FY 2025 PEPPER for Short-Term Acute Care Hospitals Webinar – April 7

CMS will hold a webinar to review the FY 2025 fourth quarter Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) for short-term acute-care hospitals on Tuesday, April 7 at 1:00 (eastern). During the session, CMS will provide guidance on navigating the program’s recent changes, including a review of reports published in March of 2026.  Go here to register to participate and to submit questions to be addressed during the webinar.

CMS – Medicare Diabetes Prevention Program Enrollment Procedures Webinar – April 9

CMS will hold a webinar to introduce Medicare Diabetes Prevention Program enrollment procedures, discuss how recent changes affect the program, and answer questions about program enrollment requirements and policies on Thursday, April 9 at 1:00 (eastern).  Go here to register to participate.

MedPAC – Commissioners Meeting – April 9-10

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, April 9 and Friday, April 10.  An agenda for the meeting and information about how to participate have not yet been posted; when they are, they will be found here.

MACPAC – Commissioners Meeting – April 9-10

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, April 9 and Friday, April 10.  Go here to register to participate.

CMS – Medicare Diabetes Prevention Program 2026 Supplier Summit – April 23

CMS will hold a Medicare Diabetes Prevention Program supplier summit on Thursday, April 23 at noon (eastern) to help program participants and suppliers learn about how the program can benefit their organization and community, learn about the differences between program delivery modalities, and receive important updates from CMS and the CDC about the new online delivery option.  Learn more about the event from this CMS notice and go here to register to participate.

HHS Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology/Health Information Technology Advisory Committee – May 7

The Health Information Technology Advisory Committee of HHS’s Office of the Assistant Secretary for Technology Policy will hold its next meeting on Thursday, May 7.  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 September 24 and November 5.