The following is the latest health policy news from the federal government for February 6-12.  Some of the language used below is taken directly from government documents.

The White House

The White House announced the launch of TrumpRx, a service that will enable consumers to purchase a limited number of discounted prescription drugs directly from the manufacturers of those drugs and in some cases from pharmacies without the benefit of health or prescription drug insurance.  Learn more about TrumpRx and its launch from this White House announcement, an accompanying fact sheet, and the TrumpRx web site.

Congress

Following passage of five appropriations bills and the health extenders package last week, Congress’s focus has shifted to the Department of Homeland Security (DHS) appropriations bill.  DHS remains the only FY 2026 spending measure still operating under a continuing resolution, which is set to expire on Friday.

340B

Following two defeats in federal court, CMS decided to end its 2025 attempt to launch its 340B Rebate Model Pilot Program.  The program would have introduced a new approach to the 340B prescription drug discount program under which a limited number of pharmaceutical companies would pay rebates to 340B-eligible entities for their purchases of drugs instead of offering discounts for the purchase of those same drugs, as has been the practice since the 340B program’s launch in 1992.  Late last year a federal court ruled against the imminent introduction of the program, doing so based largely on procedural grounds centered on inadequate notice of the program’s introduction and CMS’s failure to respond to concerns raised by interested parties during the rulemaking process, and the court then rejected the agency’s request for a stay in the delay of the program.  Last week CMS informed the court that it would discontinue efforts to appeal these rulings.  In its ruling, the court noted that if CMS chooses to attempt to introduce the program again it has agreed to do so in accordance with more appropriate guidelines for proposed rulemaking.  Less than a week after the court’s ruling, HHS’s Health Resources and Services Administration (HRSA) listed “340B Drug Pricing Program Manufacturer Rebate Models” as a “prerule” submitted to the Office of Management and Budget (OMB), as all proposed rules are, for review and possible revision prior to official publication.  This signals HRSA’s intention to relaunch the model that the court rejected.  Find that listing here and learn more about the decision that prompted HRSA’s decision to resurrect its attempt to introduce this program from the federal court ruling.

Proposed Changes in Affordable Care Act Health Exchange Plans

In its proposed Notice of Benefit and Payment Parameters for 2027, CMS has proposed significant changes in the regulations governing the types of health plans that can be offered on Affordable Care Act health exchanges and how potential buyers of those plans are deemed eligible for those plans.  The major changes include:

  • Permitting insurers to offer catastrophic plans with terms of either one year or multiple consecutive years, up to ten years.
  • Repealing standardized plan options and related limit requirements.
  • Permitting low-deductible plans with higher maximum out-of-pocket limits.
  • Realigning affordability and coverage incentives across catastrophic and metal-level plans.
  • Expanding hardship exemptions for certain individuals age 30 and older in all states.
  • Permitting non-network plans to receive Qualified Health Plan certification by demonstrating sufficient provider choice.
  • Implementing stronger eligibility and income verification and enhanced enforcement policies to ensure that premium subsidies are reserved for eligible individuals and updating exchange policies to reflect new legal requirements that limit eligibility for premium tax credits, cost-sharing reductions, and advance payments of those benefits to individuals who meet immigration eligibility standards.
  • Strengthening standards of conduct for insurance agents, brokers, and web brokers by clarifying prohibited marketing practices and reinforcing oversight to deter fraud and misleading conduct.
  • Regulating Essential Health Benefits to ensure that federal subsidies are not used to finance state-mandated benefits.
  • Updating network adequacy and provider access reviews.
  • Recalibrating risk adjustment models.

Learn more about the proposed rule, including the underlying rationale for these changes, from this CMS news release; an accompanying fact sheet; and the proposed rule itself.  The deadline for submitting comments is March 11.

Centers for Medicare & Medicaid Services
  • CMS has posted a bulletin updating ICD-10 and other coding revisions to national coverage determinations that will take effect on July 1.  Find that bulletin here.
  • CMS has posted a bulletin describing changes in the Medicare outpatient prospective payment system that took effect on January 1.  The bulletin covers coding, device pass-through status, comprehensive ambulatory payment classification, and drugs, biologicals, and pharmaceuticals.  Find the bulletin here.
  • CMS has posted a bulletin updating processing instructions and place-of-service codes for professional claims for national coverage determination 20.40:  renal denervation for uncontrolled hypertension.  Find the bulletin here.  The changes it describes took effect on October 25, 2025 and their implementation will begin on April 6, 2026.
  • CMS has fined an Indiana hospital for non-compliance with federal price transparency requirements for hospitals.  The agency found the hospital out of compliance in August of 2025 and issued the fine after a follow-up review in late January found the hospital still out of compliance with those requirements.  CMS also warned the hospital that it will be subject to additional fines if it does not bring its practices into compliance with federal law.  Learn more from CMS’s letter to the hospital announcing the fine and the reasons it has been levied.
  • CMS has contracted with a consultant to implement the Development and Evaluation of Exchange Health Plan Quality Initiatives (QRS/QIS) to fulfill an Affordable Care Act requirement.  That contractor will convene technical expert panels – groups of stakeholders and experts – to provide strategic guidance and contributions that shape the star ratings and quality improvement efforts of Qualified Health Plans offered through the health exchanges.  This technical expert panel will advise on the continued implementation of the QRS and QIS by providing input on topics such as public engagement efforts, guidance materials, data analysis and methodology, and measure set refinements.  Learn more about the technical expert panel, the backgrounds the panel seeks among potential participants, the time commitment for panel members, and how to apply to participate from this CMS notice (scroll down and click on “Development and Evaluation of Exchange Health Plan Quality Initiatives (QRS/QIS”)).  The deadline to apply to participate is February 23.
Department of Health and Human Services

HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) and its Office of the National Coordinator for Health IT (ONC) have launched a Behavioral Health Information Technology Initiative designed to close the technology gap in mental health and substance use care.  Historically, behavioral health providers were excluded from federal incentives like the HITECH Act, leading to significantly lower rates of electronic health record adoption compared to general hospitals.  Major components of the initiative include standardized data elements, a $20 million financial commitment over three years, and nine pilot projects across 45 exchange partners that are testing the real-world exchange of behavioral health data to inform future national standards.  Learn more about the program from this ONC announcement; this SAMHSA announcement; the ONC blog post “Advancing the Future of Behavioral Health Data Exchange;” and this overview of the pilot projects.

Medicaid State Plan Amendments

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

  • To New Mexico, revising the fee schedules for dental services and licensed birth centers.  It also includes grammatical updates and incorporates CMS’s standardized language to ensure consistency.
  • To New York, to reimburse for emergency medical care from the location where the care was administered.
  • To Texas, making changes in the current and approved methodology for covered services to increase the wage for personal attendants to $13.00 an hour and discontinuing the attendant compensation rate enhancement program.
  • , updating the primary home care attendant wage to increase the wage for personal attendants to $13.00 an hour and discontinuing the attendant compensation rate enhancement program.
  • To Colorado, revising the reimbursement rates on the state’s pharmacy state plan pages.  The change incorporates maximum allowable cost into the lesser-of reimbursement methodology.  Additionally, it adjusts the reimbursement rate for the lowest two professional dispensing fee tiers – pharmacies with the highest annual prescription volume – from $10.25 to $9.93 and $9.31 to $8.72.
  • To North Dakota, amending the alternative benefit state plan to include coverage for community health worker and community paramedic services.
  • To Mississippi, permitting the Division of Medicaid to include automatic enrollment of Medicaid managed care organizations, include language excluding beneficiaries receiving 1915(i) Community Support Program services from the Mississippi Coordinated Access Network and excluding tribal members from automatic enrollment.
  • To South Carolina, permitting mandatory managed care assignment for populations that currently may not be assigned to managed care.
HHS Newsletters, Reports, and Videos
Food and Drug Administration (FDA)
  • The FDA announced that it will take enforcement action against non–FDA-approved GLP‑1 active pharmaceutical ingredients.  The agency also plans to address misleading direct-to-consumer advertising and marketing practices related to these products.  Learn more from this FDA announcement.
  • The FDA has approved a first-of-its-kind medical device for the treatment of adults with locally advanced pancreatic cancer.  The device is a portable, noninvasive therapy that delivers alternating electrical fields, known as tumor treating fields, to the abdomen.  Learn more from this FDA news release.
Congressional Research Service

The Congressional Research Service has published a report on medical research funding requested of and awarded under the Department of Defense’s Congressionally Directed Medical Research Program.  Find that report here.

Stakeholder Events

CMS – Hospital Inpatient Quality Reporting Program Requirements for the FY 2028 Payment Determination Webinar – February 19

CMS will hold a webinar on hospital inpatient quality reporting program requirements for the FY 2028 payment determination on Thursday, February 19, 2026 at 2:00 (eastern).  The webinar will highlight FY 2028 hospital inpatient quality reporting program requirements and review aligned electronic clinical quality measure reporting requirements for the hospital inpatient quality reporting and Medicare promoting interoperability programs.  Find the slides for the webinar and information about how to register to participate in this CMS announcement.

HHS Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology/Health Information Technology Advisory Committee – February 19

The Health Information Technology Advisory Committee of HHS’s Office of the Assistant Secretary for Technology Policy will hold its next meeting on Monday, February 19 at 10:00 (eastern).  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 May 7, September 24, and November 5,

CMS – 2026 CMS Burden Reduction Conference – February 25

CMS will hold its 2026 Burden Reduction Conference on Wednesday, February 25.  The conference will be held in Washington, D.C., with options for individuals to attend in person or participate virtually.  Learn more from this CMS notice.  Registration information is not available at this time.

CMS – eCQI Resource Center – Expert-to-Expert Webinars on eCQM Annual Updates for 2026 – February 26, March 5, March 12, March 19

CMS’s eCQI Resource Center will hold expert-to-expert webinars offered in collaboration by the Joint Commission, CMS, and eCQM stewards.  The webinars will address the eCQM annual updates for 2026 implementation and offer continuing education credits for the live broadcast.  The webinar will address frequently asked questions and participants can submit questions for response.  The sessions, all to be held at 1:00 (eastern), are as follows:

  • February 26 – Annual Updates for PC-02 and PC-07 for 2026 Reporting Year – for more information and to register, go here.
  • March 5 – Annual Updates for STK and VTE eCQMs for 2026 Reporting Year – for more information and to register, go here.
  • March 12 – Annual Updates for Opioid Related Adverse Events eCQM for 2026 Reporting Year – for more information and to register, go here.
  • March 19 – Annual Updates for Hospital Harm-Pressure Injury eCQM for 2026 Reporting Year – for more information and to register, go here.

MedPAC – Commissioners Meeting – March 2-3

MedPAC’s commissioners will hold their next public meeting virtually on Monday, March 2 and Tuesday, March 3.  An agenda and registration information are not yet available but when they are they will be posted here.

MACPAC – Commissioners Meeting – March 5-6

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, March 5 and Friday, March 6.  An agenda and registration information are not yet available but when they are they will be posted here.

CMS – 2026 CMS Quality Conference – March 16-18

CMS will hold its 2026 Quality Conference on Monday, March 16 through Wednesday, March 18 in Baltimore.  The theme of the conference will be “Make America Healthy Again:  Innovating Together for Better Health.”  Interested parties can participate in person or virtually.  Learn more about the conference and how to register to participate from this CMS announcement.