The following is the latest health policy news from the federal government for February 20-26.  Some of the language used below is taken directly from government documents.

Congress

Both chambers of Congress are in session this week and next.  The partial shutdown of the Department of Homeland Security that began on February 23 continues.

The House Ways and Means Committee held a hearing titled “Advancing the Next Generation of America’s Health Care Workforce” to examine the shortage of resident physicians and explore ways to strengthen rural health care providers and Graduate Medical Education (GME).  Watch the hearing and review the witness testimony here.

Centers for Medicare & Medicaid Services
  • CMS, HHS, and the White House have announced new steps to crack down on fraud in Medicare and Medicaid.  The major components of this effort are a nationwide moratorium on Medicare enrollment for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers; a nationwide call to action to support fraud prevention, including stakeholder input on how CMS can continue to expand and strengthen its efforts; and the deferral of $259.5 million of quarterly federal Medicaid funding in Minnesota to prevent payment of questionable claims while further investigation is completed.  Learn more about these steps from the following resources:
  • As part of this same initiative, CMS has issued a Request for Information (RFI) soliciting stakeholder and public feedback on potential regulatory changes that might make CMS more effective in identifying and preventing fraud, waste, and abuse in CMS programs.  This RFI asks stakeholders and the public to respond to a number of specific questions that address, among others, the following issues:
    • Ways to prevent, identify, and address possible waste, fraud, and abuse in Medicaid supplemental payments, such as disproportionate share payments (Medicaid DSH) and state-directed Medicaid managed care payments.
    • Ways to prevent, identify, and address possible waste, fraud, and abuse in section 1115 and section 1915 waiver programs.
    • Ways to prevent, identify, and address possible waste, fraud, and abuse of non-federal share financing sources such as intergovernmental payments (IGTs).
    • Ways to prevent, identify, and address possible waste, fraud, and abuse in the DMEPOS field.
    • The availability, use, and cost of using AI to assist with abstracting diagnoses from medical record documentation as part of medical records review.
    • A possible requirement that states require “high-risk providers” to revalidate more frequently than every five years.
    • New approaches to provider enrollment and screening.

Learn more from this preview version of the RFI soliciting stakeholder feedback on potential regulatory change the address waste, fraud, and abuse.  The deadline for submitting comments in response to this RFI is March 27.

  • CMS and the Office of Management and Budget (OMB) have updated the Medicare Outpatient Observation Notice (“MOON”) effective immediately.  Go here to find the updated version in English and Spanish.
  • CMS has posted a fact sheet on Medicare-covered intravenous immune globulin items and services and changes in Medicare payment rates.  Find that fact sheet here.
  • CMS has posted a booklet detailing changes in the Medicare Diabetes Prevention Program Expanded Model.  Find that resource here.
  • CMS has updated its telehealth FAQ.  Find the latest version here.
  • CMS has posted a bulletin presenting the quarterly update of its Medicare clinical laboratory fee schedule and laboratory services subject to reasonable charge payment.  Go here to find that bulletin and a link to the new codes.  The changes the bulletin announces take effect on April 1.
  • CMS has posted a bulletin presenting the quarterly update of its Medicare national fee schedule for vaccine administration.  The bulletin includes codes for the administration of a recently approved medication for the treatment of serious cases of COVID-19.  Find the bulletin here.  The new fees and codes take effect on April 1.
  • CMS has posted a bulletin updating Healthcare Common Procedure Coding System (HCPCS) codes subject to and excluded from Clinical Laboratory Improvement Amendments (CLIA) edits.  Find that bulletin here.  The changes the bulletin presents take effect on April 1.
  • CMS has sent an informational bulletin to the states informing them that it does not anticipate taking enforcement action against states until December 31, 2027 for actions involving the fee-for-service grievance system requirements that were issued as part of the Ensuring Access to Medicaid Services final rule.  Under that rule, states must establish a procedure under which beneficiaries may file grievances related to the performance of person-centered service planning and home- and community-based settings requirements.  Previously, states were required to develop and implement such systems by July 9, 2026.  Learn more from CMS’s bulletin to the states.
  • CMS has published its “Electronic Clinical Quality Measures (eCQMs) Annual Update Pre-Publication Document,” which provides the versions of the standards and code systems used within the updated eCQMs for potential use in CMS quality reporting programs for the 2027 reporting/performance period.  The pre-publication document is designed to prepare health information technical/electronic health record developers, eligible clinicians, and hospitals for 2027 reporting/performance through the pre-release of the expected standards and code system versions.  The updated eCQMs will be available on the Electronic Clinical Quality Improvement (eCQI) Resource Center in the spring of 2026.  Learn more from this CMS announcement.
  • CMS has announced the creation of what it is calling a “Medicare App Library.”  According to the agency,

The Medicare App Library is a trusted, centralized directory where people with Medicare can discover and access vetted digital health care options. We use “apps” as an inclusive term that encompasses traditional mobile and web applications, technology-enabled care services, digital health platforms, and innovative care delivery tools. All care options in the library will have undergone rigorous evaluation to ensure they meet high standards for security, privacy, clinical evidence, usability, and equity.

CMS adds that “We are calling on health app developers, tech-enabled organizations, and innovators to voluntarily align around a shared framework for data and access that empowers people, improves care, and accelerates progress.”

Learn more about the library, how it will operate, its intended uses, and more from the new Medicare App Library web page.

Department of Health and Human Services
  • In support of its consideration of proposing a new rebate model for the 340B Drug Pricing Program, HHS’s Health Resources and Services Administration (HRSA) has proposed a new information collection initiative that would include the collection of proposed rebate model plans from qualifying drug manufacturers; the collection of reports from drug manufacturers approved for participation to enable HRSA’s Office of Pharmacy Affairs to evaluate the pilot program and enhance 340B program integrity and compliance monitoring; and the collection of data submitted by covered entities to participating drug manufacturers to request rebates in connection with a potential 340B rebate model pilot program.  Learn more about this information collection proposal from this formal HRSA notice.  The deadline for stakeholders to submit comments is April 27.
  • HRSA has extended the deadline for stakeholders to submit comments on its Request for Information on a prospective 340B rebate model pilot program.  Previously March 19, that deadline is now April 20.  Learn more from this HRSA notice.
Medicaid State Plan Amendments 

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

  • To Montana, assuring that medication-assisted treatment for opioid use disorders as defined at section 1905(ee)(1) of the Social Security Act(the Act) is a covered Medicaid benefit.
  • To Arkansas, carving out selected drugs from the DRG reimbursement for hospitals and using actual acquisition cost instead.
  • To New Jersey, increasing the fee schedule transportation rate for Medicaid members for partial care services.
  • To Ohio, updating the state’s Medicaid payment methodology for ambulatory surgical centers by implementing ambulatory surgical center-specific Enhanced Ambulatory Patient Groups (EAPG) relative weights, increasing the ambulatory surgical center dental flat rate, and decoupling ambulatory surgical center reimbursement from outpatient hospital rates to increase payments.
  • To Tennessee, describing coverage of substance use disorder treatment services for eligible individuals who are patients in eligible Institutions for Mental Diseases.
  • To Wyoming, removing the sunset date from Attachment 3.1-M and permanently attesting to the state’s mandatory compliance with Section 5121 of the Consolidated Appropriations Act of 2023.
  • To Hawaii, updating provider licensure and enrollment requirements to comply with 42 CFR Part 455.
  • To Maine, enacting a quality bonus pool based on performance measures and promoting access to care and quality of care by incorporating value-based payment.
  • To Georgia, updating the add-on payment for the Rural Hospital Newborn Delivery Program from $1,000 to $3,000 per newborn delivery for hospitals in rural counties having populations less than 35,000 and providing an enhanced payment to hospitals for newborn deliveries in rural counties having populations between 35,001 and 50,000 in the amount of $1,500 per delivery.
  • To Pennsylvania, making annual updates to the Healthcare Common Procedure Coding System for individual practitioners, outpatient clinic services, and dental services.
HHS Newsletters, Reports, and Videos
Food and Drug Administration (FDA)

The FDA has issued draft guidance for sponsors seeking full approval for targeted individualized therapies by generating substantial evidence of effectiveness and safety when randomized controlled trials are not feasible due to small patient populations because the diseases they seek to treat are “ultra-rare.”  The draft guidance focuses on therapies that target a specific genetic, cellular, or molecular abnormality and are designed to correct or modify the underlying cause of disease.  The new framework allows for a  single adequate and well-controlled clinical investigation supported by strong scientific rationale instead of multiple trials.  Learn more about the new proposed FDA standard from this HHS news release and from the draft guidance itself.  The deadline for stakeholders to submit comments about the proposed guidance is April 27.

Government Accountability Office (GAO)
Stakeholder Events

MedPAC – Commissioners Meeting – March 2-3

MedPAC’s commissioners will hold their next public meeting virtually on Monday, March 2 and Tuesday, March 3.  Go here to see the meeting’s agenda and for information about how to register to participate.

CMS – Innovation in Behavioral Health (IBH) Model Cohort II NOFO Webinar – March 5

CMS will hold a webinar on the notice of funding opportunity (NOFO) it has issued for new participants in its Innovation in Behavioral Health Model on Thursday, March 5 at 2:00 (eastern).  The Innovation in Behavioral Health Model is a state-based model that leverages the relationships of people with Medicare and/or Medicaid with specialty behavioral health practices to provide whole-person, integrated care that seeks to better address their behavioral, mental, and physical health.  Topics covered during the webinar will include model payment methodology, federal award details, and the application process.  Learn more about the webinar and find links to webinar presentation materials in this CMS notice and go here to register to participate.

CMS – eCQI Resource Center – 2026 eCQM Annual Updates Webinars – March 5 (and others)

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

  • 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.

MACPAC – Commissioners Meeting – March 5-6

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, March 5 and Friday, March 6.  Go here to register to participate.

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.

CMS – Medicare Drug Price Negotiation Program Public Engagement Events – April 6-23

From April 6 through April 23, CMS hold a series of public information events to gather stakeholder information about its Medicare Drug Price Negotiation Program and the specific prescription drugs covered by that program.  The agency invites patients, caregivers, clinicians, and others to share their experience relevant to the drugs selected for negotiation and renegotiation under the program.  Learn more from this CMS bulletin about the public informational events and learn more about the individual events, the specific drug or drugs each event will address, and how to participate from this CMS web page.

HHS Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology/Health Information Technology Advisory Committee – May 7

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 September 24 and November 5.