The following is the latest health policy news from the federal government for August 15-21.  Some of the language used below is taken directly from government documents.

Congress

The House and Senate are in recess and will return to Washington D.C. on September 2.  Funding for the federal government expires on September 30, as will a number of health care extenders, including for telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments.

In the fall, Congress is considering pursuing health care legislation along two tracks, one a potentially bipartisan package and another a potential reconciliation bill.  Lawmakers are preparing a broad health care package for action this fall that could address expiring health care programs along with potential reforms in Medicare Advantage, pharmacy benefit manager regulation, Medicare site-neutral payment policies for hospitals, and Medicare reimbursement changes for long-term acute-care hospitals – all proposals that could move with support from both sides of the aisle.

Medicare Sequestration/Spending Cuts

In a letter to Democratic congressional leaders, the Congressional Budget Office (CBO) has explained that the FY 2025 budget reconciliation act passed by Congress – the so-called “One Big Beautiful Bill” – could lead to more than $500 billion in federal Medicare spending cuts between next year and 2034.  The federal “PAYGO” law requires spending cuts to offset any new spending included in newly passed legislation.  With the FY 2025 reconciliation law estimated to increase the federal budget deficit $3.4 trillion through 2034 and many federal programs exempt from such cuts, the CBO estimates that Medicare sequestration cuts – reduced Medicare payments to providers, which are limited to four percent a year under the PAYGO law – could amount to $45 billion in FY 2026, $48 billion in FY 2027, $54 billion in FY 2028, $52 billion in FY 2029, $58 billion in FY 2030, $62 billion in FY 2031, $66 billion in FY 2032, $75 billion in FY 2033, and $76 billion in FY 2034 – more than $500 billion.  Find the CBO letter here.

Centers for Medicare & Medicaid Services
  • CMS has launched an initiative to ensure that enrollees in Medicaid and CHIP are U.S. citizens, U.S. nationals, or have a “satisfactory” immigration status.  CMS will begin providing states with monthly enrollment reports identifying individuals whose citizenship or immigration status could not be confirmed through federal databases and states will then be responsible for reviewing cases, verifying the citizenship or immigration status of identified individuals, requesting additional documentation if needed, and taking appropriate actions if necessary, including adjusting coverage or enforcing non-citizen eligibility rules.  CMS has already begun sending its monthly reports to the states.  According to the agency, “Individuals without satisfactory immigration status may only receive limited services in certain circumstances.”  Learn more about this initiative from this CMS news release.
  • HHS and CMS have announced the creation of a “Healthcare Advisory Committee” – a group of experts charged with delivering strategic recommendations to HHS Secretary Kennedy Jr. and CMS Administrator Oz on how to improve how care is financed and delivered across Medicare, Medicaid and CHIP, and the Health Insurance Marketplace.  CMS is accepting nominations for individuals to serve on the advisory committee.  Learn more about the scope of activity of the advisory committee, the areas of expertise the agency seeks from prospective members, and how to submit nominations from this CMS news release.  Nominations will be accepted for 30 days after formal publication of the notice of the committee’s formation, currently scheduled for August 22.  Find a pre-publication version of that notice here.
  • CMS has posted an FAQ on its Wasteful and Inappropriate Service Reduction Model (WISeR).  The program is a new CMS effort that will seek to reduce waste, fraud, and abuse in Medicare by making greater use of prior authorization and pre-payment reviews for a small group of medical items and services that it considers susceptible to misuse or unnecessary use.  Find the FAQ here.  The six-year model program begins on January 1 in selected regions chosen by CMS.  Learn more about the WISeR model here.
  • CMS has released hospital-specific reports for severe obstetric complications and patient safety indicator measures that will be publicly reported in the fall of 2025.  Learn more about the measures that were reported and how to review individual hospital reports and submit questions about the CMS calculations from this CMS announcement.  The deadline for submitting comments is September 3.
  • CMS has updated its web page about flu shot frequency, coverage, and billing for providers serving Medicare patients.  Find that updated page here.
  • CMS has updated its Medicare Part C organization, determinations, appeals, and grievances web-based training program to clarify the number of days to file appeals.  Find the updated training program here.
  • CMS has updated its Medicare Part D coverage, determinations, appeals, and grievances web-based training program to clarify the number of days to file appeals.  Find the updated training program here.
  • CMS has updated its booklet “Information for Critical Access Hospitals.”  Find it here.
  • CMS has posted a guide for the transition of Clinical Laboratory Improvement Amendments (CLIA) to a paperless notification system for receiving electronic CLIA fee coupons and certificates.  After March 1, 2026, paper fee coupons and CLIA certificates will no longer be available.  Find the guide here.
  • CMS is temporarily pausing its Nursing Home Compare updates as it transitions to a new cloud-based reporting system.  Learn more about the pause, the new system, and when the updates will resume from this CMS notice.
  • A CMS contractor is recruiting inpatient hospitals to assist with testing a Tobacco Use Screening and Cessation Intervention eCQM that assesses the percentage of persons 12 years of age and older who were screened for tobacco use one or more times during the measurement period and who received tobacco cessation intervention during the measurement period or the 180 days prior to the measurement period if identified as a tobacco user.  Learn more about the testing protocol and how to express interest in participating from this eCQI Resource Center notice.  The deadline for applying to participate is September 19.
  • CMS has added the following items to its Quality Payment Program resource library.  All of these links are direct downloads of zip files.
Department of Health and Human Services
  • HHS’s Office of the Assistant Secretary for Technology Policy (ASTP) has published a report on the growth of health IT-enabled patient engagement capabilities among hospitals from 2021 through 2024.  This report examines trends in hospitals’ adoption of nine key patient engagement capabilities in both inpatient and outpatient settings, including the ability of patients to view, download, transmit, and import data from other organizations into their patient portal; view clinical notes; and gain access to information through apps.  It also explores variation by hospital and health IT characteristics.  Learn more from this ASTP report.
  • HHS’s Health Resources and Services Administration (HRSA) has awarded more than $15 million in grants to 58 recipients under its Rural Health Care Services Outreach Program, which seeks to implement disease prevention and health promotion activities, expand access to care, and improve health outcomes in rural areas.  Through collaboration with local networks of partnering organizations, awarded grants will seek to use innovative, evidence-informed models to address the distinct needs of the rural communities they serve.  Learn more about the program and find a list of the grant recipients in this HRSA announcement.
  • HRSA is considering adding Duchenne muscular dystrophy and metachromatic leukodystrophy to the Recommended Uniform Screening Panel and is seeking public feedback about these possibilities.  Learn more about HRSA’s consideration of these possible additions from this notice about the possible addition of Duchenne muscular dystrophy and this notice about the possible addition of metachromatic leukodystrophy.  The RUSP is a list of disorders that HHS recommends for states to screen as part of their state universal newborn screening programs.  The deadline for submitting comments on both is September 15.
Medicaid State Plan Amendments

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

  • To Massachusetts, updating base per diem rates and making provisions for new and existing supplemental payments.  It also makes technical edits to existing supplemental payments.
  • To Massachusetts, making changes to reimbursement for nursing facility services, including updates to specified cost adjustment factors and establishing new add-on and supplemental payments.
  • To Massachusetts, updating reimbursement for inpatient psychiatric and substance abuse treatment hospital services for rate year 2025.
  • To Washington, updating the effective date of the fee schedules for several Medicaid services.
  • To Texas, updating the payment rate and rate methodology for the pediatric care facility special reimbursement class of nursing facilities.
  • To Texas, updating physician and other practitioners’ program fee schedules.
  • To Mississippi, updating the calculation of prescribed pediatric extended care rates to use the 2023 average small nursing facility rates.
  • To South Dakota, adding alternative benefit plan coverage for doula services.
  • To Nebraska, extending the recovery audit contractor for two years.
  • To Hawaii, modifying coverage of dental services to include dental providers who see individuals with intellectual/developmental disabilities and challenging behaviors and to include coverage of non-fluoride agents.
  • To New Hampshire, increasing the medically needy income limit.
  • To North Carolina, confirming the state’s compliance with Section 5121 of the 2023 Consolidated Appropriations Act to provide screening, diagnostic, and targeted case management services to eligible juveniles as defined in the Social Security Act.
  • To Virginia, eliminating the requirement for consumer-directed services facilitators to have an associate or bachelor’s degree to provide services.  Work experience shall be listed as sufficient in the list of requirements.
State-Directed Medicaid Payments

CMS has approved the following state applications for Medicaid state-directed payments.

  • , implementing minimum fee schedules established by the state for the rating period of January 1, 2025 through December 31, 2025, to be incorporated into capitation rates through a risk-based rate adjustment for the following provider classes and services:  nursing facilities; HCBS providers for individuals who are elderly and/or have physical disabilities; HCBS providers for individuals with intellectual and developmental disabilities; providers of behavioral health crisis prevention, intervention, and stabilization service for individuals with intellectual disabilities; behavioral health mobile crisis centers; and dental service providers.
  • To Texas, for delivery system and provider payment initiatives under Medicaid managed care plan contracts for the rating period covering September 1, 2024 through August 31, 2025, which were incorporated into capitation rates through a risk-based rate adjustment.
  • To New Hampshire, implementing a uniform dollar increase for community mental health program services for the rating period covering July 1, 2025 through June 30, 2026, to be incorporated into capitation rates through a separate payment term of up to $2.65 million.
  • To New Hampshire, implementing a uniform dollar increase for children’s inpatient and outpatient services with recognized children’s hospitals established by the state for rating periods covering July 1, 2025 through June 30, 2026, to be incorporated into capitation rates through a separate payment term amount of up to $1.3 million.
  • To Wisconsin, implementing a uniform dollar increase for ground emergency ambulance services for the rating period covering January 1, 2024 through December 31, 2024, which was incorporated into capitation rates through a risk-based rate adjustment.
  • To North Carolina, to implement a minimum fee schedule established by the state for public ambulance provider services for the rating period covering July 1, 2025 through June 30, 2026, to be incorporated in the capitation rates through a risk-based rate adjustment.
  • To North Carolina, implementing a minimum fee schedule established by the state for eligible non-state government-owned skilled nursing facilities for actual utilization of services for rating periods covering July 1, 2025 to June 30, 2026, to be incorporated into capitation rates through a risk-based rate adjustment.
  • To North Carolina, implementing a minimum fee schedule established by the state for local health department services for rating periods covering July 1, 2025 through June 30, 2026, to be incorporated into capitation rates through a separate payment term amount of up to $82.9 million.
  • To New Mexico, implementing a uniform increase for primary care services for the rating period covering July 1, 2024 through December 31, 2024, which was incorporated into capitation rates through a separate payment term amount of up to $7 million.
  • To New Mexico, renewing a uniform increase for primary care services for the rating period covering January 1, 2025 through December 31, 2025, to incorporated into capitation rates through a separate payment term amount of up to $26 million.
  • To New Mexico, renewing the uniform percentage increase established by the state for qualified practitioners who are members of a practice plan under contract to provide professional services at a state-owned academic medical center for the rating period covering January1,  2025 through December 31, 2025, to be incorporated into capitation rates through a separate payment term of up to $34 million.
  • To New Mexico, to implement a uniform increase for HCBS and personal care services for the rating period covering July 1, 2024 through December 31, 2024, which was incorporated into capitation rates through a separate payment term amount of up to $77.52 million.
  • To Virginia, implementing a uniform percentage increase for physicians employed by or contracted with a private acute-care type 2 hospital system with at least a level 2 trauma center as of January 2022 with at least 290 beds in cost report period 2020 located in the Eastern Health Planning Region, for the rating period July 1, 2025 through June 30, 2026, to be incorporated into capitation rates through a separate payment term up to $8.57 million.
  • To Virginia, implementing a uniform percentage increase for physician services by physicians employed by or contracted with an acute-care hospital chain with a level one trauma center in the Tidewater Metropolitan Statistical Area in 2020, for rating period July 1, 2025 through June 30, 2026, to be incorporated into capitation rates through a separate payment term amount of up to $21.1 million.
  • To Oregon, implementing a uniform dollar increase for dental services for the rating period covering January 1, 2025 through December 31, 2025, to be incorporated into capitation rates through a risk-based adjustment.
  • To Oregon, implementing value-based payments for dental providers for the rating period covering January 1, 2025 through December 31, 2025, to be incorporated into capitation rates through a risk-based adjustment.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – August 21
  • CDC – Morbidity and Mortality Weekly Report – “Vaccination Coverage Among Adolescents Aged 13–17 Years — National Immunization Survey-Teen, United States, 2024” – August 14
Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC has updated its issue brief describing rate-setting for Medicaid home- and community-based services.  Find the updated report here.

Department of Labor/OSHA

The Occupational Safety and Health Administration (OSHA) is extending by 60 days the period for submitting comments on the Notice of Proposed Rulemaking on Occupational Exposure to COVID-19 in Health Care Settings to give stakeholders additional time to review the notice and collect information and data necessary for comment.  The rule requires employers to provide certain protections to their workers and report certain data.  The new deadline is November 1.  Learn more about the notice and how to submit comments from this OSHA notice.

Office of Personnel Management

The Office of Personnel Management has issued a memo announcing that for plan year 2026, chemical and surgical modification of an individual’s sex traits through medical interventions, including gender transition services, will no longer be covered under the Federal Employees Health Benefits Program and the Postal Service Health Benefits Program.  This policy applies regardless of age.  The memo also notes that as an exception, counseling services for possible or diagnosed gender dysphoria must still be covered. Covered counseling services must be provided by a licensed mental health provider and may include those who provide faith-based counseling.  Learn more from this Office of Personnel Management memo.

Congressional Research Service
Stakeholder Events

CMS – Advisory Panel on Hospital Outpatient Payment Meeting – August 25

CMS’s Advisory Panel on Hospital Outpatient Payment will meet virtually on Monday, August 25 at 9:30 (eastern).  The panel advises CMS on the clinical integrity of the Ambulatory Payment Classification (APC) groups and their associated weights.  Learn more about the panel and the meeting’s agenda from this CMS formal notice.

MedPAC – Commissioners Meeting – September 4-5

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, September 4 and Friday, September 5.  An agenda and registration information are not yet available but when they are they will be posted here.

HHS – Using Data to Empower Patients – September 8-9

HHS’s Physician-Focused Payment Model Technical Advisory Committee will hold a two-day event building on its series of discussions on developing and implementing PB-TCOC (Reducing Barriers to Participation in Population-Based Total Cost of Care) models.  These meetings, to be held on Monday, September 8 and Tuesday, September 9, will focus on using data and health information technology to empower patients and support providers.  Interested parties may attend in person, follow a live stream, or dial in for audio only.  Go here to learn more about the two-day event, including registration information (registration is required) and agendas.

MACPAC – Commissioners Meeting – September 18-19

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, September 18 and Friday, September 19.  An agenda and registration information are not yet available but when they are they will be posted here.