The following is the latest health policy news from the federal government for December 5-11.  Some of the language used below is taken directly from government documents.

Congress

The Senate voted today on competing proposals to address health care affordability:  Democrats sought a clean extension of the Affordable Care Act premium tax credits set to expire on December 31 while Republicans tried to consolidate support around an alternative plan.  Neither bill gained the 60-vote threshold needed for passage.

In the House, Speaker Mike Johnson (R-LA) intends to bring a vote on a health care package next week but at this time it is not expected to include extension of the Affordable Care Act premium tax credits.  At the same time, bipartisan groups of rank-and-file lawmakers in both chambers are pursuing various approaches that incorporate guardrails on any proposed extensions.  Without clear backing from House leadership, Representative Brian Fitzpatrick (R-PA) filed a discharge petition to compel a vote on legislation that would extend enhanced Affordable Care Act subsidies, with additional eligibility requirements, for two years.

MedPAC:  Preliminary 2027 Rate Recommendations

Members of the Medicare Payment Advisory Commission met virtually last week and reviewed and discussed preliminary proposals for 2027 Medicare rates and other Medicare payment issues.

Leading the agenda for the two days of meetings was a review of the adequacy of current Medicare payments and discussion about rate 2027 rate recommendations for:

  • hospital inpatient and outpatient services
  • physician and other health professional services
  • inpatient rehabilitation facility services
  • skilled nursing facility services
  • home health care services
  • hospice services
  • outpatient dialysis services

MedPAC members also discussed:

  • their mandated report on rural emergency hospitals
  • an update on site-neutral payments, including the possibility of making greater use of site-neutral payments for the delivery of Medicare-covered services
  • trends and key issues in acute care
  • improving Medicare’s payment approaches
  • a mandated report on the impact of recent changes in the home health prospective payment system
  • a mandated report on MedPAC’s assessment of the Medicare ground ambulance data collection system

The prospective payment changes discussed during this meeting were only preliminary recommendations; MedPAC will make its official recommendations to Congress early next year.  Among its preliminary recommendations, MedPAC called for:

  • increasing Medicare inpatient and outpatient payments by the amount provided for in current law
  • increasing physician and other provider payments 0.5 percent
  • reducing payments to inpatient rehabilitation facilities and home health providers by seven percent
  • reducing skilled nursing facility payments by four percent

MedPAC also reiterated its past recommendation to move from away Medicare disproportionate share (Medicare DSH) payments and to distribute future supplemental Medicare payments to qualified hospitals based on a hospital safety-net index of its own devising supplemented with an additional $1 billion.

Go here for a transcript of the meeting and links to staff presentations on each of the issues listed above, including assessments, discussions of key points, data, and preliminary recommendations for 2027 changes in Medicare payments.

Centers for Medicare & Medicaid Services
  • CMS has issued additional guidance to the states on how to implement the work and community engagement requirements that were established as part of the criteria for Medicaid eligibility under H.R. 1, commonly known as the One Big Beautiful Bill Act, which was adopted and signed into law in July.  States must implement these requirements by January 1, 2027 but may choose to do so earlier.  In providing this guidance, CMS enumerates four major principles, quoted below:
    • Connect Members to Work and Community.  Center the connection between health and work through community engagement and build habits that lead to success.
    • State Flexibility.  Balance the benefits of state flexibility with the potential costs of options, including systems and operational costs.
    • Promote Alignment.  Where possible, align policies with existing statutory and regulatory requirements including existing requirements for Medicaid, SNAP, TANF, IRS, and the Marketplace.  This will help defray operations costs and streamline business flows.
    • Protect Taxpayers.  Ensure state community engagement determinations and verifications are easily auditable.

Learn more from this CMS news release; from this new, additional CMS guidance to the states; and from previous guidance CMS sent to the states on November 18.

  • Last week, CMS and its Center for Medicare and Medicaid Innovation introduced their new ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, which seeks to give original Medicare providers and patients access to high-value, technology-supported care options to better prevent and manage chronic disease.  Scheduled to launch next July 1, the ACCESS Model will employ an outcome-aligned payment option that seeks to reward results rather than required activities, enabling new ways of delivering effective technology-supported care for conditions affecting millions of Americans, including high blood pressure, diabetes, chronic musculoskeletal pain, and depression.  Last Thursday CMS hosted an event during which various agency officials discussed the program’s objectives and how it will work.  Find a video of that event here and a news release about the event here and learn more about ACCESS from the program’s web page.
  • Simultaneous with the introduction of ACCESS, the FDA announced the introduction of its Technology-Enabled Meaningful Patient Outcomes (TEMPO) pilot program for digital health devices.  TEMPO will be a voluntary pilot designed to promote access to certain digital health devices.  Through this program, the agency will evaluate a new, risk-based enforcement approach that supports digital health devices intended for use to improve patient outcomes in cardio-kidney-metabolic, musculoskeletal, and behavioral health conditions – the same conditions that are the focus of the ACCESS model.  Under the TEMPO pilot, participating manufacturers of certain digital health devices will offer devices to provide care covered by the ACCESS model while collecting, monitoring, and reporting real-world performance data.  Learn more about TEMPO from this FDA announcement.
  • CMS has published a bulletin updating Medicare deductible, coinsurance, and premium rates for CY 2026.  The update affects Medicare payments for physicians, hospitals, suppliers, and other providers that bill Medicare.  Find the bulletin here.  The new rates take effect on January 1.
  • CMS has published a bulletin presenting the annual update of its clinical laboratory fee schedule and laboratory services subject to reasonable charge payment.  Find the bulletin here.  The new rates take effect on January 1.
  • CMS has published a bulletin presenting the calendar year 2026 update to its Rural Health Clinic all-inclusive payment limit for CY 2026 and payment rates for intensive outpatient program services for Rural Health Clinics.  Find that bulletin here.  The new rates take effect on January 1.
  • CMS has updated its spousal impoverishment, Medicare savings program, and Supplemental Security Income (SSI) standards for 2026 and shared the new numbers with the states in this informational bulletin.
  • CMS has sent an informational memo to the states presenting the federal funding methodology for states’ Basic Health Programs for program year 2026.  CMS will use the same methodology it has in recent years and the memo includes updated values for various factors used in the funding calculations.  Find CMS’s memo here.
  • Short-term acute-care hospitals may now view their latest CMS “PEPPER” (Program for Evaluating Payment Patterns Electronic Reports) report.  Go here for further information and a link to the PEPPER portal.
  • CMS has published a bulletin about a new edit that will help hospice providers identify and prevent Medicare overpayments for long-term hospice care for claims submitted with matching “admission” and “from” dates.  Find that bulletin here.  The new edit takes effect on April 1, 2026.
  • CMS has published a proposed rule that would revise the Increasing Organ Transplant Access (IOTA) Model for performance year two.  The six-year, mandatory IOTA model, launched in July, seeks to increase access to kidney transplants for patients living with end-stage renal disease by creating incentives for kidney transplant hospitals to improve their care delivery capabilities and efficiency and by supporting greater care coordination and person-centeredness in the organ transplant waitlist process.  Among the changes proposed are an increase in the transplant volume for program participants, from 11 to 15 transplants, the exclusion of Department of Veterans Affairs and military hospitals, new beneficiary protections, and others.  Go here to find the proposed regulation and learn more about the program from the IOTA Model web page.  The deadline for submitting comments is February 9.
  • CMS has added the following items 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 has released its AI Strategy, the next phase of its effort to make AI available to the federal workforce, integrating it across internal operations, research, and public health.  The strategy, which is mostly internally focused and addresses agency work processes and operations, is built around five pillars:  ensuring governance and risk management for public trust; designing infrastructure and platforms for user needs; promoting workforce development and burden reduction for efficiency; fostering health research and reproducibility through science; and enabling care and public health delivery modernization for better outcomes.  Learn more from this HHS news release; the HHS AI strategy document; and a complementary AI compliance plan HHS issued in September.
  • HHS’s Office of the Assistant Secretary for Technology Policy (ASTP), working with the Social Security Administration and TEFCA, has released a new standard operating procedure for patients seeking determinations on their eligibility for Social Security Disability Insurance.  The process enables government entities at the federal, state, local, and tribal levels to use TEFCA to obtain information needed to determine an individual’s eligibility for non-health care government benefits.  Learn more about the new process from this ASTP notice.
  • HHS’s Health Resources and Services Administration (HRSA) has updated the OPTN (Organ Procurement and Transplantation Network) modernization web page with new content highlighting its multi-year approach to modernization.  The refreshed page now includes an outline of HRSA’s phased strategy and links to the OPTN Discovery Task summaries and full reports.  Learn more from the updated OPTN web page.
HHS/Office of the Inspector General
  • HHS’s Office of the Inspector General (OIG) has published its annual solicitation of proposals and recommendations for developing new or modifying existing safe harbor provisions under section 1128B(b) of the Social Security Act, the federal anti-kickback statute, and for developing new OIG special fraud alerts.  Learn more about those statutes, the nature of the proposals and recommendations the OIG seeks, and the criteria it will use to evaluation suggestions from this OIG notice.  The deadline for submitting proposals and recommendations is February 9.
  • Medicare improperly paid some optometrists for services provided to enrollees at nursing facilities, HHS’s OIG concluded after a recent audit.  Learn more about what the OIG learned and the steps it recommends for addressing the problems it identified from this OIG report.
  • The OIG has published two audit reports, with recommendations, on Medicare payments for podiatric services:
 Medicaid State Plan Amendments

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

  • To Delaware, renewing a uniform percentage increase established by the state for personal care service claims for the rating period covering January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a risk-based rate adjustment of up to $14.5 million.
  • To Delaware, establishing a minimum fee schedule for nursing facility services for the rating period covering January 1, 2025 through December 31, 2025, which was incorporated into capitation rates through a risk-based rate adjustment of up to $235.6 million.
  • To Ohio, renewing a uniform percentage increase for professional services provided by qualified practitioners affiliated with or employed by an academic medical center at participating health systems affiliated with a public medical school in the Southwest class established by the state for the rating period January 1, 2025 through December 31, 2025, which was incorporated into the capitation rates through a risk-based adjustment and a separate payment term of up to $1.8 million.
  • To Ohio, renewing a uniform percentage increase for professional services provided by qualified practitioners affiliated with or employed by an academic medical center at participating health systems affiliated with a public medical school in the Northeast class established by the state for the rating period January 1, 2025 through December 31, 2025, which was incorporated into the capitation rates through a risk-based adjustment and a separate payment term of up to $6.8 million.
  • To New Mexico, renewing a uniform dollar increase established by the state for eligible government-owned emergency medical transport providers for the rating period covering January 1, 2026 through December 31, 2026, to be incorporated into capitation rates through a separate payment term of up to $19.46 million.
  • To Rhode Island, renewing a uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term of up to $324.7 million.
  • To Louisiana, renewing a uniform increase for in-state, non-rural providers of inpatient and outpatient hospital services, excluding freestanding psychiatric hospitals, freestanding rehabilitation hospitals, and long-term acute-care hospitals, for the rating period from July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term of up to $3.8 billion.
  • To Louisiana, establishing a uniform increase for in-state, rural providers of inpatient and outpatient hospital services, excluding freestanding psychiatric hospitals, freestanding rehabilitation hospitals, and long-term acute-care hospitals, for the rating period from July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term of up to $314.8 million.
  • To Louisiana, renewing a uniform increase for inpatient and outpatient hospital services by eligible in-state hospital providers of long-term acute care, psychiatric services, and rehabilitation services for the rating period from July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term of up to $61.5 million.
  • To Louisiana, amending a uniform dollar increase for pediatric home health nurses established by the state for home health services for the rating period from July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term of up to $3.3 million.
  • To New Jersey, amending the uniform increase for inpatient hospital services provided by Mercer County hospitals for the rating period covering July 1, 2023 through June 30, 2024, which was incorporated into capitation rates through a separate payment term of up to $65.9 million.
  • To New Jersey, renewing a uniform increase for nursing facility services provided by Class II (publicly owned) nursing facilities with more than 500 licensed beds for the rating period from July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term of up to $18.2 million.
  • To New Jersey, renewing a uniform dollar increase for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screening services for the rating period covering July 1, 2025 through June 30, 2026, incorporated into capitation rates through a risk-based rate adjustment.
  • To New Jersey, increasing the adult medical day care provider per diem rate.
  • To New Jersey, increasing adult and pediatric primary care services fee schedule rates.
  • To New Hampshire, renewing a uniform dollar increase for inpatient and outpatient hospital services to qualifying non-critical access hospitals for rating periods covering July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term amount of up to $104.8 million.
  • To New Hampshire, establishing a uniform dollar increase for inpatient and outpatient hospital services to qualifying hospitals for rating periods covering July 1, 2025 through June 30, 2026, incorporated into capitation rates through a separate payment term amount of up to $$75.3 million.
  • To Nebraska, renewing a uniform increase for non-state-owned or operated hospitals established by the state for inpatient and outpatient hospital services for the rating period January 1, 2025 through December 31, 2025, which was incorporated into capitation rates through a separate payment term of up to $1.4 billion.
  • To Michigan, renewing a uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering October 1, 2025 until September 30, 2026, incorporated into capitation rates through a risk-based rate adjustment.
  • To North Carolina, renewing a uniform dollar increase for eligible behavioral health inpatient services for the rating period covering July 1, 2025 through June 30, 2026, incorporated into capitation rates through a risk-based rate adjustment of up to $136.4 million.
  • To North Carolina, adding the Children and Families Specialty Plan as a specialized managed care organization authorized under the state’s 1115 demonstration authority to provide 1915 services.
  • To Florida, renewing the minimum fee schedule established by the state for eligible ground emergency transportation services for the rating period covering July 1, 2025 through June 30, 2026, incorporated into capitation rates through a risk-based rate adjustment of up to $45.5 million.
  • To Florida, renewing a uniform percentage increase for professional services at an academic medical center for rating periods covering February 1, 2025 through September 30, 2025, which was incorporated into capitation rates through a separate payment term amount of up to $227.6 million.
  • To Florida, authorizing the state to enter into value-based purchasing arrangements on a voluntary basis with drug manufacturers and removing vaccine language in the covered legend drugs section.
  • To Maryland, renewing the minimum fee schedule for primary care services for the rating period covering January 1, 2026 through December 31, 2026, incorporated into capitation rates through a risk-based rate adjustment of up to $10.8 million.
  • To Maryland, renewing population-based payment for primary care services for the rating period covering January 1, 2026 through December 31, 2026, incorporated into capitation rates through a separate payment term amount of up to $29.3 million.
  • To Maryland, updating an additional eligibility requirement that for states to be eligible to receive funds through the pay-for performance program, nursing facility providers must not be identified by the department as failing to pay the quality assessment in accordance with established timetables.
  • To Massachusetts, updating the methods and standards used by the state for payment for community behavioral health centers for mobile crisis intervention and standard and intensive outpatient services.
  • To Massachusetts, updating the methods and standards for payment for personal care attendants and transitional living providers.
  • To South Carolina, adding intensive outpatient and partial hospitalization programs as a psychiatric benefit provided in outpatient hospital services.
  • To Nevada, eliminating the sunset provision of September 30, 2025 and establishing permanent mandatory medication-assisted treatment benefits.
  • To Arizona, confirming the state’s compliance with Section 5121 of the 2023 Consolidated Appropriations Act to establish Medicaid coverage for screening, diagnostic, and targeted case management services to eligible juveniles.
  • To Wisconsin, updating provider qualifications for psychotherapy and medication management under the rehabilitative services and prescribed drugs benefits.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – December 11
  • HHS/Health Resources and Services Administration (HRSA) – last week HRSA held a webinar about its 340B Drug Pricing Program Rebate Model.  Find a video and transcript of that webinar here.
  • HRSA –NHSC (National Health Service Corps) State Loan Repayment Program Technical Assistance Webinar Recording – December 3
  • Agency for Healthcare Research and Quality – AHRQ News Now – December 10
  • CDC – Mortality and Morbidity Weekly Report – “Human-to-Human Rabies Transmission via Solid Organ Transplantation from a Donor with Undiagnosed Rabies — United States, October 2024–February 2025” – December 4.
Centers for Disease Control and Prevention (CDC)
  • The CDC’s Advisory Committee on Immunization Practices (ACIP) voted to recommend individual-based decision-making for parents deciding whether to give the hepatitis B vaccine, including the birth dose, to infants born to women who test negative for the virus.  For those infants not receiving the birth dose, ACIP suggested that the initial dose be administered no earlier than two months of age.  Learn more about this and other aspects of ACIP’s hepatitis B vaccine recommendations from this HHS news release.  A recommendation from ACIP becomes part of the CDC immunization schedule only after it has been adopted by the CDC’s director.
  • The CDC has posted an update on its ongoing investigation of infant botulism cases linked to ByHeart infant formula.  CDC investigators have expanded the outbreak date range to include 10 cases dating back to December 2023.  As of December 10, 2025, 51 sick infants from 19 states have been hospitalized and treated in these cases but no deaths have been reported.  Learn more from this CDC news release.
Department of the Treasury/Internal Revenue Service

The Department of the Treasury and the IRS have issued guidance on new tax benefits for Health Savings Account (HSA) participants under the “One Big Beautiful Bill Act” passed this summer.  These changes expand HSA eligibility, which will enable more people to save and to pay for health care costs through tax-free HSAs.  Learn more from this IRS news release and the Treasury/IRS guidance.

Congressional Research Service

 The Congressional Research Service has published a comparison of the work requirements for Medicaid eligibility and the Supplemental Nutrition Assistance Program (SNAP) based on the changes in Medicaid eligibility criteria introduced in the “One Big Beautiful Bill Act” passed this summer.  Find the report here.

Stakeholder Events

 CMS – Healthcare Common Procedure Coding System (HCPCS) Level II public meeting – December 17

CMS will hold a virtual Healthcare Common Procedure Coding System (HCPCS) Level II public meeting on Wednesday, December 17 at 9:00 (eastern) to discuss its preliminary coding, Medicare benefit category, and Medicare payment determinations, if applicable, for new revisions to the HCPCS Level II code set for non-drug and non-biological items and services.  Learn more about the meeting, including how to register and how to participate, from this CMS notice.

AHRQ – Prepping for the Future:  Digital Solutions for Aging Populations – December 17

HHS’s Agency for Healthcare Research and Quality (AHRQ) will hold a webinar on “Prepping for the Future:  Digital Solutions for Aging Populations” on Wednesday, December 17 at 1:30 (eastern).  AHRQ’s presenters will share research on how digital tools can improve health outcomes for older adults, explore barriers to adoption, and discuss strategies to ensure that these technologies are accessible, user-friendly, and effective.  Learn more about the webinar, continuing education credits for participating, and how to register from this AHRQ notice.

HHS/Office of the Assistant Secretary for Technology Policy – ASTP Annual Meeting – February 11-12, 2026

HHS’s Office of the Assistant Secretary for Technology Policy will hold its annual meeting in Washington, DC on February 11-12, 2026.  The meeting will include in-person education and plenary sessions and networking opportunities for the health IT community.  The main stage plenary sessions will also be available for viewing online.  ASTP will soon post information on the meeting’s agenda, how to register, and how to reserve a hotel room through ASTP’s room block.  When it does, that information will be posted here.