The following is the latest health policy news from the federal government for August 22-28.  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 reductions to Medicaid disproportionate share (Medicaid DSH) allotments.

Congressional Budget Office (CBO)

The CBO has written to congressional leaders in response to their request for information about the effects of the recently passed FY 2025 budget reconciliation bill (the “One Big Beautiful Bill” Act) on health insurance purchased through the Affordable Care marketplaces, on improper receipt of subsidies, and on the effects of a final rule published by HHS on marketplace subsidies.  Among the issues the CBO addresses in its letter are:

  • How many individuals will no longer be eligible for premium tax credits and no longer have health insurance because they do not meet the citizenship or immigration status criteria outlined in the bill.
  • How many non-citizens with incomes below 100 percent of the federal poverty level CBO projects will no longer be eligible for premium tax credits and no longer have health insurance because of the bill.
  • How many individuals CBO projects will no longer receive premium tax credits and not have subsidized health insurance because they are not completing the verification requirements under the bill.
  • How many individuals CBO projects will no longer receive premium tax credits and not have subsidized health insurance due to the changes to the special enrollment period for individuals with certain incomes under the bill and whether such individuals will otherwise be eligible for enrollment and, if applicable, premium tax credits during the standard open enrollment period.
  • Whether the removal of the limitation on repayment of excess advanced premium tax credits under the bill change individuals’ eligibility for those credits.

Find the answers to these and other questions in the CBO letter “Clarifications of Marketplace Coverage and Eligibility Under Public Law 119-21 (H.R. 1) and the 2025 Marketplace Integrity and Affordability Rule.”

Centers for Medicare & Medicaid Services
  • CMS has posted two bulletins describing ICD-10 and other coding revisions to national coverage determinations.  The first bulletin presents coding changes that will take effect on January 1, 2026; find that bulletin here.  The second bulletin presents minor changes from the first bulletin; find it here.
  • CMS has posted a bulletin describing changes in billing practices, including criteria for eligibility for Medicare reimbursement, for home-based non-invasive positive pressure ventilation to treat chronic respiratory failure due to chronic obstructive pulmonary disease.  Find that bulletin here.
  • CMS has posted a bulletin presenting billing changes associated with national coverage of transcatheter edge-to-edge repair for tricuspid valve regurgitation.  Find that bulletin here.
  • CMS has developed and published the 2026 electronic clinical quality measure (eCQM) flows to the Electronic Clinical Quality Improvement (eCQI) Resource Center.  The eCQM flows, found on the eCQM resources tabs, supplement Hospital – Inpatient and Hospital – Outpatient eCQM specifications for the 2026 reporting period and Eligible Clinician eCQMs for the 2026 performance period.  The eCQM flows are designed to assist in interpretation of the eCQM logic and calculation methodology for performance rates and to provide an overview of each of the population criteria components and associated data elements that lead to the inclusion or exclusion into the eCQM’s quality action.  Learn more from this announcement, which includes links to the new resources.
  • 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
  • According to HHS’s Office of the Inspector General (OIG), the rates at which Medicare enrollees leave acute-care hospitals against medical advice have steadily increased since 2006 across most demographics.  In addition, enrollees who left were more likely to have poor health outcomes than enrollees discharged to their homes and the rates at which enrollees have left appear inversely correlated to the quality-of-care ratings of the associated hospitals:  the lower the rating, the higher the rates.  In addition, enrollees eligible for both Medicare and Medicaid and those with a mental health diagnosis were more likely to leave than Medicare-only enrollees and enrollees without a mental health diagnosis.  Learn more from the OIG report “Medicare Enrollees Left Acute-Care Hospitals Against Medical Advice at Increasing Rates.”
  • In a review of Medicare-covered remote patient monitoring, the OIG found that the use of such services has the potential to greatly expand in the future and that additional oversight of remote patient monitoring is needed.  Learn more from the OIG report “Billing for Remote Patient Monitoring in Medicare.”
  • CMS should confirm that it is receiving Medicare post-operative visit data on global surgeries when reporting is required, the OIG has concluded after a recent audit.  Learn more about the why the OIG performed this review, what it found, and what it recommends to address the problems it uncovered from this OIG report.
  • HHS’s Health Resources and Services Administration (HRSA) has introduced a public dashboard that tracks when organ offers and transplants occur outside the standard list of matched patients. The tool also tracks trends to help HHS crack down on noncompliance and give patients, families, and clinicians clear information about whether the system is operating fairly.  Learn more about the dashboard and why the agency developed it from this HRSA news release.
Medicaid State Plan Amendments

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

  • To Maine, extending the state’s Maine’s Recovery Audit Contractor (RAC) program exception from June 1, 2025 through May 31, 2027.
  • To Maine, updating the total inpatient pool amounts for the total critical access hospital supplemental pool and the total acute care hospital supplemental pool.
  • To Kentucky, implementing a quality program funded by a provider assessment and clarifying how payment for ancillary services is part of the per diem rate.
  • To Missouri, adding a prospective payment system and an alternative payment method for provider-based rural health clinics.
  • To Nevada, enhancing the nursing facility sections for both nursing facilities and institutions for mental diseases over 65 benefits by adding clarifying language to the authorization process and updating terminology and demonstrating adherence to federal and state requirements.
  • To Wisconsin, adding additional coverage and payment details for delivering school-based services.
  • To New Hampshire, amending the Title XIX State Plan in response to the Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system final rule issued by CMS on November 27, 2024.
HHS Newsletters, Reports, and Videos
Medicaid and CHIP Payment and Access Commission (MACPAC)

In a new report, MACPAC provides state-level information on Medicare crossover policies for inpatient hospital services, outpatient hospital services, nursing facility services, and physician services for dually eligible Medicare and Medicaid individuals.  Under federal law, states have options for how much they pay for eligible services – their “crossover policies.”  Learn more about how states exercise this option from the MACPAC issue brief “State Medicaid Payment Policies for Medicare Cost Sharing.”

Medicare Payment Advisory Commission (MedPAC)

MedPAC has submitted formal comments to CMS in response to CMS’s proposed rule addressing how it intends to regulate and pay home health providers, providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and others in calendar year 2026.  In its letter, MedPAC endorses CMS’s proposal to reduce Medicare payments for home health services by six percent and expresses its support for more competitive bidding for DMEPOS contracts and for increased oversight over DMEPOS suppliers.  Learn more from MedPAC’s letter to CMS.

Food and Drug Administration (FDA)

The FDA announced that it has begun daily publication of adverse event data from the FDA Adverse Event Reporting System (FAERS).  FAERS is the FDA’s primary database for collecting and analyzing adverse event reports, serious medication errors, and product quality complaints for prescription drugs and therapeutic biologics and includes reports submitted by health care professionals, consumers, and manufacturers.  Learn more about the publication of the daily report from this FDA announcement and about the FAERS dashboard here.  Find the dashboard itself here.

Government Accountability Office (GAO)

Medicaid programs that cover prescription drugs are generally required to cover drugs that are approved by the FDA and made by a manufacturer that participates in the Medicaid Drug Rebate Program.  According to a GAO review, however, 13 state Medicaid programs did not cover Mifeprex and its generic equivalent, Mifepristone tablets, when required.  These drugs are used for medical abortion.  Learn more about what the GAO found and its recommendations from its new report “Medical Abortion:  Action Needed to Ensure Compliance with Medicaid Drug Rebate Program.”

Congressional Budget Office (CBO)

The CBO has updated two of its past reports on long-term services and supports:  “Overview of Long-Term Services and Supports” and “Who Pays for Long-Term Services and Supports?”

Stakeholder Events

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.