The following is the latest health policy news from the federal government for April 4-10.  Some of the language used below is taken directly from government documents.

Congress
  • The House and Senate were in recess this week and are scheduled to be back in session on April 14.
  • House Speaker Mike Johnson (R-LA) has indicated that the House will not vote on the Senate‑passed Department of Homeland Security continuing resolution until there is meaningful progress on a reconciliation package to fund U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection.  In an effort to narrow the scope of a party-line bill to focus only on immigration policies and to meet President Trump’s June 1 deadline, Republican lawmakers are discussing a possible future third reconciliation measure to address their additional budgetary priorities before the mid-term elections. Health care interests are concerned that the House could seek to pay for additional spending in a narrow reconciliation bill with Medicare and/or Medicaid spending cuts.
    • Some Republican members are considering adding health care provisions to such a bill, including expanded access to health savings accounts; changes to the rate at which the federal government matches state Medicaid spending (FMAP); changes to Medicaid pharmacy benefit manager (PBM) spread pricing; and site-neutral payment policies.
  • The House Ways and Means Committee will hold a hearing on health care affordability that is tentatively scheduled for April 28.  Among the expected subjects to be addressed during this hearing will be the role of hospitals in rising health care costs; federal programs that create incentives for consolidation in the hospital industry; and whether consolidation can help preserve access to care, including in rural areas.  Among those who reportedly have been invited to participate in the hearing are representatives of NewYork-Presbyterian, ECU Health, CommonSpirit Health, and HCA Healthcare.
  • The Senate Health, Education, Labor & Pensions (HELP) Committee will hold a hearing on April 16 titled “Making Medicines More Affordable:  How Competition Can Lower Drug Prices.”  Members will discuss how Congress can lower the cost of prescription drugs by increasing competition among generic and biosimilar manufacturers.  See the press release here.  A recording of the hearing will be posted here.
  • The House Ways and Means Committee will hold a hearing on April 14 titled “Modernized Health Care in Practice:  Empowering Americans to Live Healthier Lives.”  Committee members will examine how modern health care can better prioritize wellness and create incentives for innovation to improve patient outcomes.  Learn more from this committee news release.  A recording of the hearing will be posted here.
  • The Ways and Means Committee will hold a full committee hearing with HHS Secretary Robert F. Kennedy, Jr. on April 16 to discuss HHS’s priorities.  Learn more from this committee news release.  A recording of the hearing will be posted here.
The White House

Last week the administration sent an outline of its proposed FY 2027 budget to Congress.  The proposed budget requested $111.1 billion in discretionary budget authority for HHS for 2027, a $15.8 billion or 12.5 percent decrease from the 2026 enacted level.  Now, the administration has released more detailed documentation describing its specific intentions for HHS as a whole and for CMS in particular.  For more information on proposed funding and policies for specific programs, see the more detailed HHS budget proposal and the more detailed CMS budget proposal.  It is important to note that these documents are statements of administration priorities and are not binding.  Congress makes the final decisions on how federal resources are allocated.

340B

A federal court has overturned a 2013 policy of the Health Resources and Services Administration (HRSA) that limited how some 340B-eligible hospitals could purchase 340B-covered drugs.  HRSA’s policy, commonly known as its group purchasing organization or GPO exclusion, prohibited some Medicare disproportionate share (Medicare DSH) hospitals from purchasing prescription drugs in advance of dispensing them, including them in a commingled drug inventory that included other prescription drugs, and then retroactively identifying which drugs in that inventory qualified for the 340B discount.  The decision noted that for some hospitals, “… the costs of complying with the 2013 Policy ‘range anywhere from $500,000 to $1.6 million’ per hospital and that ‘virtually all of America’s 5,000+ hospitals’ use GPOs as “sourcing and purchasing partners…”  The court did not rule that the HRSA policy itself was illegal; it found only that the agency failed to provide adequate justification for its implementation.  Learn more from the court’s decision in the case.

Centers for Medicare & Medicaid Services (CMS)
  • CMS has published its CY 2027 Medicare Advantage and Part D Rate announcement.  CMS anticipates spending 2.48 percent more on Medicare Advantage in CY 2027, which is significantly more than the 0.9 percent it proposed earlier this year when it published its draft advance notice for the upcoming year.  When accounting for estimated risk score trend in Medicare Advantage due to factors such as population changes and coding practices, CMS notes that this amounts to a 4.98 percent rate increase.  The rate announcement also addresses coding differentials between Medicare Advantage and original Medicare; calls for the exclusion of diagnosis information from unlinked chart review records; finalizes updates to the Part D risk adjustment model that include accounting for Inflation Reduction Act changes to the Part D benefit for CY 2027; and aligns sources of diagnoses for use in risk adjustment to be consistent with similar policies finalized for Medicare Advantage.  Learn more about the CY 2027 Medicare Advantage and Part D Rate announcement from this CMS news release; an accompanying fact sheet; and the rate announcement itself.
  • CMS has written to state health care officials to provide guidance on their implementation of section 71109 of last year’s H.R. 1, often referred to as the “One Big Beautiful Bill Act.”  This section, titled “Alien Medicaid Eligibility,” takes effect on October 1 and generally limits federal financial participation (FFP) for Medicaid and CHIP, with limited exceptions – primarily, medical emergencies – to U.S. citizens and U.S. nationals, lawful permanent residents, Cuban/Haitian entrants, and Compact of Free Association migrants.  The letter addresses in detail the limitations on FFP and potential effects on eligibility and availability of coverage, the implications for current beneficiaries, and the changes states may need to make to their systems and processes prior to October 1, 2026 to comply with these statutory changes.  Among those changes, states will need to update their eligibility and verification systems, including eligibility redeterminations and how providers and managed care plans submit claims and pursue state Medicaid plan amendments.  Learn more about the new guidelines that will take effect on October 1 from this CMS letter to state health officials and this CMS news release.
  • Last month, CMS sent a memo to state Medicaid directors on the implementation of Medicaid eligibility redetermination requirements that were introduced in last year’s H.R. 1.  Now, the agency has posted a slide deck that elaborates on last month’s memo and the legislation’s requirements.  The slide deck includes an overview of last year’s legislation, the transition to six-month eligibility renewals, special considerations, and next steps for states.  Learn more from the new CMS slide deck and last month’s CMS memo to state Medicaid directors.
  • As part of an event to advance what it calls the country’s “HealthTech Ecosystem,” CMS this week highlighted technology tools from more than 50 companies, many of which are already available or will be available to the public soon.  These efforts are part of the agency’s broader initiative to create a connected digital health ecosystem in which patients can access, share, and use their health information through trusted applications.  CMS explains that it is working to develop shared standards for identity, security, and interoperability in ways that it hopes will reduce administrative burden, accelerate innovation, and support a more connected, value‑driven health system.  Learn more about CMS’s “HealthTech Ecosystem Live!  First Wave Launch” event from this CMS news release and its new Health Technology Ecosystem web page.
  • CMS has posted a reminder to facilities participating in its hospital outpatient quality reporting program that they face May deadlines for submitting selected quality measures for the fourth quarter of calendar year 2025 and for all of CY 2025.  Learn more about the specific measures for which reporting is required and how to submit that data from this CMS notice.
  • CMS has updated its hospital price transparency FAQ and posted a new FAQ on encoding algorithms with example scenarios to provide additional information on implementation of the CY 2026 hospital outpatient prospective payment system and ambulatory surgical center final rule.  Find the hospital price transparency FAQ here and the encoding algorithm examples here.
  • CMS has posted a bulletin presenting its April quarterly update for the 2026 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule.  Find that bulletin here.  The updates it presents took effect on April 1.
  • CMS is requesting Office of Management and Budget (OMB) approval for the self-attestation for recertification of comprehensive outpatient rehabilitation facilities (CORFs), outpatient physical therapy/speech language pathology providers, Rural Health Clinic providers, and portable x-ray suppliers through four new collection instruments.  A CORF, or “facility,” is defined as a non-residential facility that is established and operated exclusively for the purpose of providing diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons at a single fixed location by or under the supervision of a physician.  Learn more about how CMS defines these provider types, the requirements they must meet under Medicare’s Conditions of Participation, and the attestations CMS seeks from this CMS notice.
  • CMS has sent a memo to state survey agency directors clarifying Nurse Aide Training Competency Evaluation Program and Nurse Aide Competency Evaluation Program requirements and permissible flexibilities to expand capacity for nurse aide trainees to foster increased nurse aide staffing in nursing homes.  Find that memo here.
  • 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
  • HHS’s Health Resources and Services Administration (HRSA) has announced more than $135 million in new funding opportunities to expand nutrition services and strengthen the rural health workforce.  HRSA will spend $125 million for expanded nutrition services to help more than 350 HRSA-funded health centers to expand access to nutrition services and food-based interventions within primary care settings and will spend an additional $11.25 million in its Rural Residency Planning and Development Program, awarding up to 15 grants of up to $750,000 each over three years to support new rural residency programs in high-need specialties, including family medicine, internal medicine, psychiatry, ob/gyn, general surgery, and preventive medicine.  Learn more from this HHS news release; this more detailed description of the Rural Residency Planning and Development Program; and this more detailed description of the anticipated Notice of Funding Opportunity, which HRSA expects to post on April 14 with an estimated application deadline of May 29.
  • HHS’s Office of the Inspector General has issued a favorable opinion regarding a state-designated domestic crisis provider’s proposal to bill federal health care programs for therapy services furnished by a requestor’s employed mental health professionals and to waive any cost-sharing for such services.  Find that opinion here.
Medicaid State Plan Amendments

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

  • To California, adding encounters between a patient and a psychological associate for Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Tribal FQHCs as prospective payment system billable visits.
  • To Iowa, permitting the state to enter into value-based supplemental rebate agreements with drug manufacturers on a voluntary basis.
  • To Minnesota, providing an increase to both the base rates and rate enhancement for support workers under the 1915k benefit.
  • To Minnesota, providing an increase to both the base rates and rate enhancement for support workers under the 1915i benefit.
  • To Minnesota, implementing the state’s annual rate increases for home care services and personal care assistant services.
  • To Montana, amending the fee schedules for services listed on the introduction pages and for other rehabilitative services.
  • To New York, increasing EPSDT early intervention service rates while reducing telehealth early intervention reimbursement.
  • To North Dakota, amending the state plan to update service definitions and update practitioners to various services.
  • To Pennsylvania, updating the state plan to connect targeted support management to a 1915(b)(4) selective contracting waiver.  This includes changes to providers’ qualifications to require a signed agreement that requires compliance with performance measures, changes to payment rates from 15-minute units to monthly case rates, and a flat rate for initial plan development.
  • To Utah, authorizing an add-on rate for residents in nursing homes who meet specific behaviorally complex requirements.
  • To Utah, clarifying the state’s pharmacy billing policy regarding maximum allowable costs and 340B pricing.
HHS Newsletters, Reports, and Videos
Stakeholder Events

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 and go here to learn about livestreamed town hall meetings.

CMS – Listening Session on Patient Empowerment Care – April 13

CMS will hold a beneficiary listening session focused on patient experiences in health care for improving access, transparency, and affordability on Monday, April 13 at 2:30 (eastern).  Learn more about the event and how to register to participate from this CMS notice.

Clinical Lab Fee Schedule Data Collection Webinar – April 16

Some clinical laboratories may be required to submit data to CMS in the Fee-for-Service Data Collection System Clinical Lab Fee Schedule Module starting on May 1.  In anticipation of this requirement, CMS will hold a clinical lab fee schedule data collection webinar on Thursday, April 16 at 3:00 (eastern).  During this webinar, CMS will provide an overview of this data collection initiative; highlight how clinical laboratories can determine whether they are affected labs; discuss preparation activities and resources; and demonstrate the module.  Go here to register to participate.

Medicare Cost Report E-Filing System Webinar – April 22

CMS will hold a webinar on the Medicare cost report e-filing system on Wednesday, April 22 at 1:00 (eastern).  During this webinar, the agency will address new and upcoming functionality for Medicare Part A cost reports and hospice cap determinations in the Medicare Cost Report e-filing system.  Go here (and scroll down to “Medicare Cost Report E-Filing System Webinar – April 22”) to learn more about the webinar and 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.

CDC – Clinician Outreach Call on Rabies – April 30

The CDC will hold a call for clinicians on Thursday, April 30 at 2:00 (eastern) during which it will discuss the current rabies landscape in the U.S. and CDC resources to help clinicians and health departments with risk assessments.  Presenters also will highlight animal-related costs and effects from rabies and how risk assessments can help avoid financial damage from costs associated with rabies exposures.  Learn more about the event and its objectives, additional resources, how to participate, and how to obtain continuing education credits for participating from this CDC notice.

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.