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 today passed the budget resolution passed by the Senate last week.  Passage of the same budget resolution by both chambers now enables Congress to begin work on a reconciliation bill to enact President Trump’s priorities on tax cuts, border security, and energy policies.  Until this morning, more than a dozen Republican House members had opposed the Senate-passed budget resolution because they believed the Senate’s budget did not require enough spending cuts.  Ultimately, all but two House Republicans – Thomas Massie (KY) and Victoria Spartz (IN) – voted for the resolution after Senate Majority Leader Thune (SD) and Speaker Johnson (LA) publicly promised to seek at least $1.5 trillion in cuts to safety-net programs.  The budget resolution maintains instructions to the House Energy and Commerce Committee, which has jurisdiction over Medicaid and some Medicare, to find $880 billion in savings over the next ten years.
  • Starting today, Congress will leave for a two-week recess, returning to Washington D.C. on April 28.  The budget resolution requires committees to submit legislation that complies with the resolution’s instructions to their chamber’s respective budget committees by May 9.
  • The Senate has confirmed Mehmet Oz, M.D., to serve as Administrator of the Centers for Medicare & Medicaid Services.
  • Twenty-six members of Congress have written to the Secretary of Commerce and Office of the U.S. Trade Representative to express their concern about the potential for tariffs and retaliatory measures to affect health care supply chains, including for prescription drugs, medical supplies, and medical devices and equipment, noting that resulting shortages could harm U.S. patients.  See their letter here.
The Courts

A federal district court in Texas has struck down a federal regulation upgrading and increasing staffing standards for nursing homes.  Find the court’s decision here.

Centers for Medicare & Medicaid Services
  • CMS has published the final rule “Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.”  This regulation finalizes a provision to restrict Medicare Advantage plans’ ability to reopen and modify previously approved inpatient hospital decisions based on information gathered after the approval.  Under the new regulation, plans will only be able to reopen approved admissions “…for obvious error or for fraud or similar fault.”  With this final rule, CMS codifies aspects of the Medicare Prescription Drug Benefit Program that previously had been described in sub-regulatory guidance.  The rule finalizes new requirements for an automatic election renewal process, effective in 2026; establishes $600 or more in out-of-pocket costs for a single prescription as a threshold for justifying targeted outreach to potential program participants; and establishes requirements for Part D plans to report information related to the program on prescription drug event records and reporting at the beneficiary level.  The final rule also establishes requirements for notices that Part D sponsors must send to enrollees and the timeline for sending those notices; finalizes CMS’s proposal to require that Medicare Prescription Drug Benefit Program bills be sent separately from monthly billing statements for Part D premiums; and establishes several standards addressing the role of pharmacies in the program.  Learn more from the following resources:
  • CMS has published the regulation “Calendar Year (CY) 2026 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs.”  The agency projects a 5.06 percent increase in payments to Medicare Advantage plans in 2026, more than twice the 2.23 percent increase it originally proposed.  Learn more from the following resources:
  • CMS has posted the draft 2026 CMS Quality Reporting Document Architecture (QRDA) Category I Implementation Guide for Hospital Quality Reporting for public comment starting on April 4 and ending on April 25.  The 2025 CMS implementation guide outlines requirements for hospitals to report electronic clinical quality measures (eCQMs) for the calendar year 2026 reporting period.  Learn more about the draft implementation guide and how to submit comments from this CMS announcement.
  • CMS has fined eight Medicare Part D plans for violations of the program and the requirements of their contracts.  Go here to find a list of the plans that have been fined and links to the letters the plans received explaining their violations.
  • CMS has updated its organizational chart.  Find the updated chart here.
  • CMS has approved the following state plan amendments for Medicaid and CHIP programs.
    • To Oregon, expanding the state’s Targeted Case Management Family Connects Nurse Home Visiting program into Douglas County and revising provider qualifications for the program.
    • To Idaho, updating fee schedule language for the state plan’s service rehabilitation benefits section to comply with federal requirements and updating outdated language.
    • To Michigan, permitting coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the FDA, during drug shortages and permitting reimbursement for prescribed drugs that are not considered covered outpatient drugs using the same methodologies as covered outpatient drugs.
    • To Michigan, increasing the amount of its GME Innovations agreement with Pine Rest Christian Mental Health Services.
    • To Kansas, updating critical access hospital cost report settlements so that these funds will be split between inpatient critical access hospital adjustment factor settlements and outpatient critical access hospital adjustment factor settlements using the same percentage split as the inpatient and outpatient critical access adjustment factor settlements in 2013.
    • To Minnesota, updating rates for mental health services according to the resource-based relative value scale.
  • CMS has approved the following state requests for changes or additions to state directed Medicaid managed care payments.
    • To Louisiana, approval of a uniform dollar increase for psychotherapy services that use dialectical behavior therapy for behavioral health outpatient services for the rating period covering July 1, 2024 through June 30, 2025 and incorporated in the capitation rates through a separate payment term of up to $3.3 million.
    • To Louisiana, approval of a uniform dollar increase for psychotherapy services that use dialectical behavior therapy for behavioral health outpatient services for the rating period covering January 1, 2025 through December 31, 2025 and incorporated in the capitation rates through a separate payment term of up to $172,000.
    • To Louisiana, approval of a uniform increase for licensed mental health providers and certain provisionally licensed mental health providers who perform specific services for the rating period covering July 1, 2024 through June 30, 2025 and incorporated into the capitation rates through a separate payment term up to $18.4 million.
    • To Arizona, approval of a uniform increase for inpatient and outpatient hospital services at freestanding children’s hospitals with more than 100 licensed pediatric beds for the rating period covering October 1, 2024 through September 30, 2025 and incorporated in the capitation rates through a separate payment term of up to $59.1 million.
    • To Wisconsin, approval of minimum and maximum fee schedules established by the state for the rating period, January 1, 2025 through December 31, 2025 and incorporated into the capitation rates through a risk-based rate adjustment.
    • To Kansas, approval of a uniform percentage increase for inpatient and outpatient hospital services provided by eligible general hospitals for the rating period covering January 1, 2024 through December 31, 2024 and incorporated in the capitation rates through a separate payment term of up to $41 million.
    • To Tennessee, approval of a uniform dollar increase established by the state for emergency ground ambulance services for the rating period, January 1, 2025 through December 31, 2025 and incorporated into the capitation rates through a separate payment term up to $36.6 million.
    • To Pennsylvania, approval of value-based purchasing established by the state for eligible nursing facility services for the rating period, January 1, 2023 through December 31, 2023 and incorporated into the capitation rates through a separate payment term up to $15 million.
    • To Massachusetts, approval of a uniform increase established by the state for eligible inpatient hospital services for the rating period covering January 1, 2023 through December 31, 2023 incorporated into the capitation rates for the managed behavioral health vendor through a separate payment term of up to $4.6 million.
Department of Health and Human Services
  • Questionable use of health risk assessments continues to drive up federal payments to Medicare Advantage plans by billions of dollars a year based on unsupported diagnoses for their members, HHS’s Office of the Inspector General (OIG) has concluded in a new report.  Find that report and the OIG’s recommendations here.
  • The HHS OIG has issued a favorable opinion regarding an arrangement in which a community health center proposes, during the provision of certain social services to individuals, to identify individuals in need of primary care services; inform them of the availability of such services; and schedule an appointment for them to receive primary care services or refer them to a local primary care provider.  Find the opinion here.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – April 3
  • AHRQ News Now – April 8
  • HRSA eNews – March 20
  • HRSA – Office for the Advancement of Telehealth – Announcements – March 25
Centers for Disease Control and Prevention (CDC)

The CDC has sent an alert to providers about measles, sharing information about the current prevalence of the disease and how to recognize and treat it.  Find that alert here.

Office of Management and Budget (OMB)

The OMB has published a request for information soliciting “… proposals to rescind or replace regulations that stifle American businesses and American ingenuity…” and “… comment from the public on regulations that are unnecessary, unlawful, unduly burdensome, or unsound.”  Learn more from this OMB notice.  The deadline for submitting comments will be 30 days after the notice’s official publication, currently scheduled for April 11.

Government Accountability Office (GAO)

HHS needs a more coordinated effort within its department to prevent and respond to drug shortages and cannot leave that responsibility to the FDA alone, the GAO has concluded in a new report that includes recommendations for addressing this challenge.  Find the report here.